食管-胃肌瓣胃腔内瓣膜式吻合术的临床应用研究  

Clinical application of esophagogastrostomy with valve - like muscle flap in gastric cavity

作　　者：杨国明[1] 宋立新[2] 董驹[3] 李新[4] 

机构地区：[1]唐山市丰润区中医医院外科,河北唐山064000 [2]中国人民解放军第二五五医院胸心外科 [3]唐山市华北煤炭医学院附属医院胸外科 [4]唐山市华北煤炭医学院附属医院胃镜室

出　　处：《中外医学研究》2010年第15期1-4,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的 研究减少和杜绝食管-胃吻合术后吻合口瘘、吻合口狭窄、反流性食管炎等严重吻合口并发症发生的吻合方式.方法 2000年3月至2009年8月,对5例食管下段癌,25例胃底贲门癌,1例Barretc食管行癌肿切除,食管--胃肌瓣胃腔内瓣膜式吻合术,年龄34～76岁,男25例,女6例.其中3例食管下段癌行弓上吻合,余28例均行弓下吻合.结果全组无近期手术死亡,无吻合口瘘的发生,无进食梗噎、明显返酸、嗳气、烧心、胸痛诸症状的发生.术后8～14 d对20例患者行上消化造影,影像学表现吻合口处极象正常人的贲门管存在,通畅无狭窄;患者倒立位,亦无造影剂反流.术后14 d～1.5年对20例患者行吻合口上5 cm食管、吻合口、吻合口下5 cm的胃腔内测压及食管内24 h pH的测定并行内镜检查,结果显示食管胃吻合口上方的压力明显高于吻合口下方,24 h食管 pH监测结果表明不存在病理性胃食管反流,胃镜检查20例患者吻合口上方的食管黏膜清亮、光洁,无潮红、充血、糜烂、溃疡等食管炎的征象发生.结论 食管--胃肌瓣胃腔内瓣膜式吻合术是减少和杜绝食管胃吻合术后吻合口瘘,吻合口狭窄和反流性食管炎等吻合口严重并发症的行之有效的手术方法 .Objective Explore the anastomotic model in order to reduce and avoid anastomtic fistula or stenosis,reflux esophagitis as well as other serious complications. Methods 5 cases of esophageal carcinoma,25 of fondal cardiac cancer and 1 Barrent esophagus were underwent with tumor removal and esophagogastrostomy with valve -like muscle flap in the gastric cavity from March ,2000 to August ,2009 of all cases ,25 were male,6 female,with the ages of 34 -76 years old,3 of the cases were anastomosed adore the aortic arch and the others below it. Result None of recent postoperative death, anastomotic fistula occurred, nor symptoms of dysphagia, remarkable acid regurgitation, belching, heartdurn, or thorcalgia. 20 cases were examined with upper digestive, tract comract X -ray on 8 - 14 days after surgery, and no stenosis or regurgitation were found, the imaging manifest showed the anastomosis looked like the existance of normal cardia. 1 nnergastric pressure ,24 -hour para - anastomotic pH value and endoscopy were examined with 20 patients in gastric cavity at 5cm above the anastomosis, the anastomosis and 5cm below the anastomosia during 14 days to 1.5 years after surgery. Results Showed that the pressure at upper part of anastomtic stoma was significantly higher than that of lower part. Phthological gastroesophageal regurg tation was not found by monitoring of 24 - hour para - anastomotic pH values. Esophagea mucosa at upper part of anastomtic stoma showed clear and smooth, without reddish, congestion erosion, ulcer and other signs of esophagitis. Conclusion Esophagogastrostomy with valve - like muscle flap in the gastric cavity is an effective surgical approach for prevention of postoperative anastomotic fistula or stenosis,reflux esophagitis as well as other severe complications.

关 键 词：责门癌 食管下段癌 食管外科手术 食管-胃瓣膜式吻合术 

分 类 号：R735[医药卫生—肿瘤]