消化道吻合器颈部食管胃吻合治疗食管癌346例临床报告  

Cervical esophagogastrostomy with circular mechanical stapler in the treatment of esophageal carcinoma report of 346 cases

作　　者：郭石平[1] 张弘广[1] 马炎炎[1] 王春利[1] 

机构地区：[1]山西省肿瘤医院胸外科,太原030013

出　　处：《中华肿瘤杂志》2007年第2期151-153,共3页Chinese Journal of Oncology

摘　　要：目的探讨次全食管切除胃经食管床消化道吻合器颈部食管胃吻合治疗食管癌的手术效果。方法346例食管癌患者采用左后外侧六肋间切口，游离肿瘤并行次全食管切除，清扫肿大淋巴结。取左颈部胸锁乳突肌前缘切口，游离颈段食管，将胃经食管床主动脉弓后上置颈部，行食管胃消化道吻合器吻合。分析该手术及效果。结果术后残端癌4例，发生率为1．2％。吻合口瘘19例，发生率为5．5％。术后死亡1例，死亡率为0．6％。吻合口狭窄13例，发生率为3．8％，均经食管扩张治愈。结论该术式符合肿瘤彻底切除的原则，残端癌阳性率低。胃放置于食管床内对呼吸循环影响小。使用吻合器增加了吻合的可靠性，减少了术后并发症。即使发生了吻合口瘘，处理也相对简单，死亡率低。Objective To evaluate the efficacy of esophagogastrostomy in the neck using circular mechanical stapler through the esophageal bed. Methods From March 1998 to June 2004 subtotal esophagectomy and mechanical anastomosis with stomach in the neck through the esophageal bed was carried out in 346 esophageal cancer patients. Results In this series, the positive rate of detecting residual cancer cells in the esophageal stump was 1.2% （4/346） ; anastomotic fistula was observed in 5.5% （19/346） causing one patient died; the overall operative mortality rate was 0.6% （2/346） ; esophageal anastomotic stricture developed in 3.8% （ 13/346）, which were cured by endoscopic dilatation. Conclusion This modified operation mode has low rate of complication, reducing impairement to pulmonary function due to the transposed thoracic stomach within the mediastinum instead of the thoracic cavity. Using mechanical circular stapler for anastomosis in the neck simplifies the operation and reducing the postoperative risk caused by anastomotic leak.

关 键 词：消化道吻合器 食管胃吻合 食管肿瘤 吻合口瘘 

分 类 号：R686[医药卫生—骨科学]