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我科自1992—1999年采用食管-胃一层吻合法治疗食管癌和贲门癌30例,无吻合口瘘及吻合口狭窄发生。现报道如下。 1 临床资料 本组30例,男性21例,女性9例,年龄40～70岁,平均50～60岁。食管中下段癌8例,贲门癌22例。手术经路:经左进胸行食管癌切除,颈部吻合2例,弓上吻合2例,弓下吻合4例;经左进胸贲门癌切除,弓下吻合22例。常规方法切除食管或贲门部肿瘤,切断食管时先环形切开食管肌层,略向近端推后。再切断食管粘膜,使近端食管粘膜稍长于肌层。于胃前壁大弯侧留2.5～3.0m之口作吻合。吻合时边距为0.6 cm,间距0.3 cm。吻合口后壁线结在腔内,前壁线结在腔外。其中有10例用带蒂大弯侧大网膜包绕吻合口外周并加以间断缝合固定。本组病例无吻合口瘘、出血及吻合口狭窄,均痊愈出院。术后1～2月行食管钡餐和纤维胃镜检查,吻合口直径均>0.8 cm。
Our department used esophageal-gastric one-layer anastomosis to treat esophageal and cardiac cancers in 1992-1999. No anastomotic leakage and anastomotic stenosis occurred. The report is as follows. 1 Clinical data in this group of 30 cases, 21 males and 9 females, aged 40 to 70 years, mean 50 to 60 years old. There were 8 cases of esophageal carcinoma and 22 cases of cardiac cancer. Surgical route: After resection of esophageal cancer through the left side of the chest, neck anastomosis in 2 cases, bow anastomosis in 2 cases, bow anastomosis in 4 cases; after the left chest and cardia cancer resection, bow anastomosis in 22 cases. Routine resection of esophageal or cardiac tumors, first cut the esophagus when the esophageal annular incision, slightly pushed to the proximal end. Then cut the esophageal mucosa, so that the proximal esophageal mucosa slightly longer than the muscle layer. The anastomosis was made at the mouth of the anterior wall of the stomach with 2.5 to 3.0 m left. The margin is 0.6 cm and the distance is 0.3 cm. The posterior wall line of the anastomosis is in the cavity and the anterior wall line is outside the cavity. Ten of them were wrapped around the anastomosis periphery with a large pedicled great omentum and interrupted sutured. In this group of patients, there was no anastomotic leakage, hemorrhage, and anastomotic stenosis. All patients were cured and discharged. The esophageal barium meal and fiberoptic gastroscopy were performed from January to February. The anastomosis diameter was more than 0.8 cm.