食管下段及胃底切除行“围巾式”食管-胃吻合98例分析  

Clinical efficacies of scarf-like esophagogastric anastomosis after lower esophageal and gastric fundus resection

作　　者：吴文良[1] 全卓勇[1] 刘文[1] 余阳[1] 张应天[1] 

机构地区：[1]江汉大学附属医院普外科,武汉430015

出　　处：《腹部外科》2015年第2期107-110,共4页Journal of Abdominal Surgery

摘　　要：目的介绍“围巾式”食管-胃吻合方法预防食管下段及胃底切除术后吻合口瘘和反流性食管炎的临床经验。方法回顾分析1996年1月至2013年10月98例食管下段及胃底切除术行“围巾式”食管-胃吻合病例的临床结果。98例中男性61例，女性37例；年龄42-83岁，中位年龄65岁。肝硬化门静脉高压症并食管下段胃底静脉曲张出血78例，早期食管胃结合部癌15例，贲门及胃底部间质瘤5例。术后86例获得随访，随访率为87％，随访时间3～60个月，中位随访时间42个月。结果98例中，1例术后发生残胃断口处吻合口瘘，其余97例均未发生吻合口瘘。无发生反流性食管炎病例。5例（5．1%）病人术后发生吻合口狭窄，经胃镜下球囊扩张后缓解，改进技术后再无吻合口狭窄发生。结论“围巾式”食管-胃吻合可减少食管下段及胃底切除术后吻合口瘘和反流性食管炎，是一种安全、有效的消化道重建方式。Objective To summarize our experiences of scarf-like esophagogastric anastomosis for reducing anastomotic leak and reflux esophagitis during lower esophageal and gastric fundus resection. Methods Retrospective analyses were conducted for the clinical outcomes of 98 patients, undergoing scarf-like esophagogastric anastomosis during lower esophageal and gastric fundus resection from January 1996 to October 2003. Results Among them, only 1 patient developed leak of gastric stump anastomotic stoma and none had reflux esophagitis. Anastomotic stricture occurred in 5 patients （5. 1%） during an early stage and transgastroscopic balloon dilatation was effective. No anastomotic stricture developed after improved surgical technique. Conclusions The new scarf-like esophagogastric anastomosis offers the advantages of reducing anastomotic leak and reflux esophagitis during lower esophageal and gastric fundus resection. And it is safe and effective for digestive tract reconstruction.

关 键 词：食管-胃吻合术 吻合口瘘 反流性食管炎 吻合口狭窄 

分 类 号：R615[医药卫生—外科学]