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目的探讨食管次全切除术后经食管床行食管胃主动脉弓上吻合的优越性。方法剖左胸用弯管型吻合器经食管床行主动脉弓上或胸膜顶食管胃吻合,对于主动脉弓迂曲肥大,操作困难的,可采用将胃先做成管状,经主动脉弓后绕过其上缘,牵出后与食管吻合,吻合后同时缩胃。结果本组121例一次性吻合成功,1例失败,改为颈部吻合。全组无吻合口出血,吻合口瘘1例,经胸腔冲洗,置入十二指肠营养管行肠内营养,1个半月后愈合。吻合口狭窄3例,经术后行吻合口扩张后好转,无手术死亡,术后3周可进普食,无胸胃综合征,无咳嗽时返流。结论剖左胸用弯管型吻合器经食管床行主动脉弓上或胸膜顶食管胃端侧吻合同时缩胃是一种切实可行的术式,优点突出,并发症少,术后回复快,有利于提高患者长期生活质量。
Objective To investigate the superiority of esophageal subtotal esophagectomy on esophageal and gastric aortic arch. Methods The left chest with curved tube stapler through the esophageal line on the aortic arch or pleural top esophagogastric anastomosis, tortuous hypertrophy of the aortic arch, the operation is difficult, the stomach can be made into a tube first, after the aortic arch around the upper edge, Pull out and esophageal anastomosis, anastomosis at the same time stomach. Results The group of 121 cases of successful anastomosis, one case of failure, replaced by neck anastomosis. The whole group without anastomotic bleeding, anastomotic fistula in 1 case, the thoracic rinse, into the duodenum nutrition tube enteral nutrition, 1 and a half months after healing. Anastomotic stenosis in 3 cases, after anastomosis was performed after the expansion of the dilated, no surgical death, 3 weeks after surgery can enter the general diet, without thoraco-gastric syndrome, without cough reflux. Conclusion Anatomy of the left chest elbow through the esophageal bed on the aortic arch or pleural top esophagogastric end to side anastomosis at the same time shrinking the stomach is a viable surgical procedure, the advantages of outstanding, less complications, quick recovery, is conducive to Improve long-term quality of life of patients.