食管贲门癌切除术中CDH型吻合器吻合的术后转化过程  

Postoperative Transformation in Patients Received Esophagectomy for Carcinoma and Esophagogastrostomy by CDH-Staplers

作　　者：翟伟[1] 冯伦高[1] 杨林[1] 潘永成[1] 赵霖[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胸外科,430022

出　　处：《实用癌症杂志》2001年第6期622-624,共3页The Practical Journal of Cancer

摘　　要：目的　动态观察食管贲门癌切除行食管胃机械吻合患者的术后转化过程 ,探讨其形成和处理方法。方法　在 6 8例食管贲门癌根治性切除术中 ,以CDH 2 5或 2 9型吻合器行食管胃吻合术 ,动态观察患者的术后转化过程。结果　 6 8例随访 3～ 2 9个月 ,发生胃食管反流和反流性食管炎者 ,经使用制酸剂和胃动力药后症状缓解。发生吻合口轻度狭窄 5 6例 ( 82 .4% ) ,其中 37例做了扩张治疗 ,2 4例 ( 6 4.9% )治愈 ,13例 ( 35 .1% )疗效欠佳。通过进一步随访 ,发现手术后 5个月 ,钛钉自吻合口完全脱落 ,5 6例患者出现的胃食管反流、反流性食管炎和吻合口狭窄症状自然缓解。结论　CDH型吻合器吻合具有快捷、安全和易掌握等优点 ,在食管胃吻合中完全可取代手工操作。多数患者术后通常经历反流、反流性食管炎和吻合口狭窄到吻合口再通畅的转化过程。这一转化过程与吻合口区钛钉的存在密切相关。制酸剂、胃动力药和扩张术在转化过程中起重要作用。Objective To observe continuous postoperative transformation in patients received esophagectomy for carcinoma and stapled esophagogastrostomy,and to discuss its formation and management method.Methods 68 patients underwent esophagectomy for carcinoma with stapled edophagogastrostomy.Squamous cell carcinoma was present in 41 patients and adenocarcinoma in 27.Follow-up completed in all patients.Postoperative transformation of stapled esophagogastrostomy was observed in 68 patients.Results 68 patients were all alive.With follow-up from 3 to 29 months,early gastroesophageal reflux and reflux esophagitis were observed in all patients,which were successfully relieved their symptoms by antacids and gastrointestinal requlators.Later mild anastomotic stenosis was present in 56 patients (82.4%).37of 68 patients underwent postoperative dilatation,with 64.9% of cure and good rate and 35.1% of poorer result.By the follow-up,over 5 months post operation,reflux,reflux esophagitis and anastomotic stenosis in 56 patients were naturally relieved for droping staplers off from anastomotic area.Conclusion CDH-staplers have advantages of rapidity,safe and easy operation.Stapled procedure may replace completely manual one in the esophagogastrostomy.Most of these patients often pass through a transformation from gastroesophageal reflux and reflux esophagitis to mild anastomotic stenosis.which related closely to the exist of staplers at anastomotic area.Antacids,gastrointestinal requlators and dilatation therapy may play an important roles in this transformation.

关 键 词：食管贲门癌 CDH型吻合器 食管胃机械吻合 术后转化过程 食管癌 贲门癌 外科手术 

分 类 号：R735.1[医药卫生—肿瘤] R735.2[医药卫生—临床医学]