可吸收线分层缝合法在颈部食管胃吻合术中的应用  

Application of laminated anastomosis with absorbable suture in cervical esophagogastrostomy

作　　者：陈名久[1] 吴显宁[1] 尹邦良[1] 胡建国[1] 喻风雷[1] 

机构地区：[1]中南大学湘雅二医院心胸外科,长沙410011

出　　处：《中南大学学报（医学版）》2011年第3期265-269,共5页Journal of Central South University ：Medical Science

摘　　要：目的:观察采用可吸收线分层缝合法行食管胃颈部吻合的临床效果,降低食管胃颈部吻合口术后狭窄的发生率。方法:2008年1月至2010年6月,在中南大学湘雅二医院胸外科接受手术治疗的210例食管癌切除颈部吻合手术患者,96例采用传统全层间断内翻缝合法,114例采用可吸收线黏膜层与浆肌层分层缝合法进行胃食管吻合。术后1周、1月、3月行食管造影,在造影片上测量吻合口的左右径及前后径,算出吻合口面积。同时根据患者进食梗阻情况,评估狭窄程度。结果:2组均无手术死亡病例,无严重肺部并发症和乳糜胸发生,术后亦无严重食管返流病例。吻合口分层缝合组无吻合口瘘发生,全层内翻缝合组吻合口瘘发生率为2.1%(2/96)。术后1周、1月、3月吻合口面积全层内翻缝合组与分层缝合组比较差异有统计学意义(P<0.01)。全层内翻缝合组与分层缝合组吻合口术后1月、3月轻、中、重度狭窄发生率差异有统计学意义(P<0.01)。结论:采用可吸收线浆肌层与黏膜层分层缝合较全层内翻缝合能明显降低食管胃颈部吻合口狭窄的发生率。Objective To observe the clinical results of laminated anastomosis using absorbable suture in cervical esophagogastrostomy,and to reduce the incidence of cervical esophagogastric anastomotic stricture.Methods A retrospective analysis was carried out on 210 patients who underwent cervical esophagogastrostomy after subtotal esophagectomy from January 2008 to June 2010.Among them,96 cases were treated with traditional full layer interrupted varus suture（varus group） and the remaining 114 cases were treated with seromuscular layer and mucosal layer laminated anastomosis with absorbable suture（laminated group）.Esophageal angiography was performed in 1 week,1 month,and 3 months after the operation.The diameter of anastomatic stoma was measured on the anteroposterior and lateral angiography image respectively.The area of anastomatic stoma was calculated.The degree of stenosis was assessed according to the patients＇ dysphagia symptom.Results There was no operative deaths,no serious pulmonary complications and chylothorax,no sever esophageal reflux in all patients.The ratio of cervical esophagogastric anastomotic leakage was 2.1%（2/96） in the varus group.No anastomotic leakage in the laminated group.Compared with the varus group,the area of the anastomatic stoma in the laminated group was significantly increased in all measured time points（P0.01）.The incidence of obstruction in the laminated group was decreased significantly（P0.01） in 1 month or in 3 months after operation compared with the varus group.Conclusion Application of the laminated anastomosis with absorbable suture in cervical esophagogastrostomy can significantly reduce the incidence of anastomotic stenosis.

关 键 词：食管癌 食管胃吻合术 狭窄 分层缝合法 

分 类 号：R735.1[医药卫生—肿瘤]