经腹经裂孔纵隔内食管-胃和食管-空肠双吻合新技术的应用  

Transabdominal and transhiatal esophagogastrostomy or esophagojejunostomy using novel double stapling technique

作　　者：王自强[1] 孟文建[1] 邓祥兵[1] 张元川[1] 魏明天[1] 杨廷翰[1] 

机构地区：[1]四川大学华西医院胃肠外科中心,成都610041

出　　处：《中华胃肠外科杂志》2012年第6期585-588,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：四川省科技厅支撑计划项目（2010SZ0070）

摘　　要：目的探讨经腹经裂孔行扩大近端胃或全胃切除术后，在纵隔内完成食管-胃或食管-空肠吻合的方法。方法2010年5月至2012年1月，对15例食管胃交界部腺癌患者在施行开放经腹膈肌裂孔扩大胃切除术或全胃切除术后，采用腹段食管逆向置入抵钉座、弧形吻合器切断食管、利用缝线牵出抵钉座的方法予以双吻合技术完成食管-胃或食管-空肠吻合，其中9例为近端胃大部切除行食管-管状胃端端吻合，6例为全胃切除术行食管-空肠吻合。结果全部病例吻合过程顺利，手术时间（185．5±13．1）min，吻合耗时（42．0±8．6）min，术中出血量（106．7±34．9）ml，食管切缘距肿瘤近端（4．4±1．2）cm．残端均无癌残留。无手术死亡及吻合口瘘发生，术后随访发现1例吻合口狭窄．经扩张后缓解。结论抵钉座逆向置人食管联合弧形切割闭合器双吻合技术能简单而安全地在下后纵隔完成食管-胃或食管-空肠吻合．可能成为食管胃交界处癌行扩大胃切除术后的一种较理想的吻合方式。Objective To explore the techniques of esophagogastrostomy or esophagojejunostomy in the mediastinum through the abdomen and hiatus after extended proximal gastectomy or total gastrectomy. Methods From May 2010 to January 2012, 15 patients with esophagogastric junction carcinoma underwent open transhiatal extended gastrostomy or total gastrectomy. After full mobilization, the anvil was reversely introdunced into the esophagus and the esophagus was transected with curved stapler. The rod of the anvil was then pulled out with a stitch to complete esophagogastrostomy after proximal gastrectomy （n=9） or esophagojejunostomy after total gastrectomy （n=6）. Results The anastomosis was successfully performed in all the patients. The mean operation time was （185.5＋13.1） min. The mean operation time for anastomosis was （42.0_＋8.6） min. The mean estimated blood loss was （106.7_＋34.9） ml. The proximal resection margin was （4.4_＋1.2） cm. All the margins were negative for residual cancer. There was no postoperative death or fistula. During the follow up, there was one case of anastomotic stenosis which was successfully managed by endoscopic balloon dilatation. Conculsions Esophagogastrostomy or esophagojejunostomy can be safely performed with double stapling technique including reverse anvil introduction and curved stapling transection of the esophagus. It is an ideal technique for anastomosis after extended gastreetomy for esophagogastric junction carcinoma.

关 键 词：食管胃交界部腺癌 扩大胃切除术 双吻合技术 消化道重建 

分 类 号：R735.2[医药卫生—肿瘤]