吻合口扁唇瓣样内凸胃底成形在贲门癌手术中的临床研究  

CLINICAL STUDY ON THE APPLICATION OF FLAT LABIAL PALPS PROJECTING INWARD TO BUILD THE STRUCTURE OF GUBAROFF FLAP

作　　者：孙照军[1] 陈涛[1] 

机构地区：[1]临沂市中医医院,山东临沂276002

出　　处：《山东医学高等专科学校学报》2013年第6期408-411,共4页Journal of Shandong Medical College

基　　金：临沂市科技发展计划项目(No:201313042)

摘　　要：目的探索贲门癌根治术后吻合口并发症的防治方法。方法将120例患者分为观察组和对照组各60例。对照组采用常规食管一胃一次性吻合器吻合法，观察组在常规吻合器吻合后，再将胃壁半包绕缝合在吻合口及食管下段，对侧用纵隔胸膜悬吊包埋使吻合口扁唇瓣样内凸建立类似Gubaroff瓣，并将胃大弯侧向上提1．5～2．0cm与纵隔胸膜固定形成His角，从而在解剖学上建立了类似正常的贲口胃底结构。观察术后返流性食管炎、吻合口狭窄、吻合口瘘的发生情况。结果观察组返流20例，对照组返流41例，差异统计学意义（P〈0．01）。两组吻合口狭窄、吻合口瘘、胃排空障碍的发生率比较差异均有统计学意义（P〈0．01）。结论在常规食管胃吻合的基础上，加胃半包绕食管下段、胃底再造、胸膜悬吊术式，使吻合口呈扁唇瓣洋凸入胃腔内，建立了类似“Gubaroff”瓣和“His”角，取得了良好的效果，能够显著减少术后并发症的发生。Objective To explore the prevention and treatment of anastomaotic complications after radical correction of cardiac carcinoma. Methods 120 cases were randomly divided into the observation group and the control group which received gastroesophageal stapling anastomosis. The observation group got rou- tine stapling anastomosis, and gastric wall was half-wrapped around stoma and inferior segment of oesoph- agus. On the opposite side, the mediastinal pleura was suspended and imbedded to make the flat labial palps project inward to build the structure of Gubaroff flap and the greater gastric curvature was raised by 1.5-2.0cm to form “His” angle with mediastinal pleura so as to set up the structure of cardiac gastric fun- dus. The back-streaming esophagitis, stoma stenostomia and stoma fistula were observed. Results There existed significant difference when comparing 20 cases of back flow I the observation group and 41 cases in the contrast group（ P 〈0. 01）. There existed significant difference in stoma stenostomia, stoma fistulae and the incidence of gastric emptying disorder（ P 〈0.01）. Conclusion In addition to gastroesophageal anas- tomosis, half- wrapping the inferior segment of esophagus, inferior segment of esophagus and pleural membrane ventrofixation were used to make the stoma protrude into gastral cavity so as to establish “Gubaroff” flaps and “His ” angle, which reduced postoperative complications effectively.

关 键 词：贲门癌 胃底成形 术后并发症 

分 类 号：R735.2[医药卫生—肿瘤]