贲门癌切除术中食管-胃黏膜套叠式吻合方法探讨  

Treatment of esophagus-gastriomucosa intussusception anastomosis in cardiac cancer

作　　者：何宗战 杨运启 宋爱玲 

机构地区：[1]解放军71352部队医院

出　　处：《现代肿瘤医学》2009年第8期1476-1477,共2页Journal of Modern Oncology

摘　　要：目的:探讨贲门癌切除后行消化道重建术式的改进,预防吻合口瘘及吻合口狭窄的措施。方法:对2000年1月-2006年12月收治的289例贲门癌患者采用食管全层与胃黏膜套叠式吻合术患者临床资料进行回顾性分析。结果:术后出现吻合口瘘3例(1.0%),肺部感染7例(2.4%)。根治性切除276例,姑息性切除13例。胃切缘和食管切缘均无癌细胞残留。随访6个月-2年出现反流性食管炎12例(4.2%),吻合口狭窄2例(0.7%),吻合口处肿瘤复发1例(0.3%),死亡4例(1.4%)。吻合口瘘、吻合口狭窄和反流性食管炎三大并发症发生率为5.9%(17/289)。结论:贲门癌切除后行食管-胃黏膜套叠式吻合局部血运佳,解剖层次清楚,对位良好,吻合方法简单,安全,可靠,胃粘膜下层覆盖食管肌层,形成的活瓣质地柔软,结合紧密,起到人工瓣膜的作用,有效预防局部感染,具有一定的抗反流作用,有利于减少吻合口瘘和吻合口狭窄的发生,提高患者生活质量。Objective： To approach the improvement in alimentary tract reconstruction after the operation of cardiac cancer, and measurements to prevent anastomotic leakage and anastomosis stricture. Methods：The clinical data of 289 cases with cardiac cancer treated with esophagus - gastriomucosa intussusception anastomosis from January 2000 to December 2006, were analyzed retrospectively. Results： Of the 289 cases, there were 3 cases with anastomotie leakage ,7 cases with pneumonia. Among them ,276 cases underwent radical operation of the tumor, 13 underwent palliative surgery. No left cancer tissues was found in the ends of eardia and esophagus. There were 12 eases（4.2% ） with gastroesophageal reflux,2 cases（0.7% ） with anastomosis stricture,1 case（0.3% ） with recurrence and 4 eases（ 1.4% ） dead of callbacks between 6 months to 2 years. The rate of the three postoperative complications, anastomotie leakage, anastomosis stricture and gastroesophageal reflux, was 5.9% （ 17/289 ）. Conclusion： It is effective to adopt the esophagus - gastriomucosa intussusception anastomosis in cardiac cancer. The blood circle is good, aratomieal hierarchy distinct ,jointed perfect, arastomosis method convenient, safe and reliable. The valve, which acts upon as a man - made valve, combined closely with gastriomucosa covering esophaguslnusele tissue, is soft, good at preventing infection, and superior in anti - esophagus reflux. It also reduces the happeness of anastomotie leakage and anastomosis stricture, and would improve the patients＇life quality.

关 键 词：贲门癌 食管 胃黏膜 吻合术 

分 类 号：R735.2[医药卫生—肿瘤]