不同食管胃胸内吻合方式在食管癌手术中的应用  

Application of different intrathoracic esophagogastric anastomosis in surgery for esophageal cancer

作　　者：韩逸超 张亚杰[1] 李鹤成[1] Han Yichao;Zhang Yajie;Li Hecheng(Department of Thoracic Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院胸外科,200025

出　　处：《中华胃肠外科杂志》2018年第9期995-1000,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：上海市科学技术委员会课题（16411966100）;“研究型医师”以及“临床专职科研队伍”项目（20172005）;上海市卫计委优秀学科带头人（2017BR055）

摘　　要：食管癌中较大比例为中下段食管癌．食管胃胸内吻合为中下段食管癌的最主要消化道重建方式。尽管食管癌消化道重建技术及器械在不断发展进步．手术后吻合口并发症发生率仍然较高，包括吻合口漏和吻合口狭窄等。目前常见的食管胃胸内吻合方式包括了手工吻合和器械吻合。本研究回顾了有关不同的食管胃胸内吻合方式比较的国内外文献报道，从手术技术操作、吻合口并发症发生率、术后病死率等方面对不同吻合方式的研究结果进行总结和比较。结果表明，各种吻合方式均拥有其自身特点及优劣，如器械吻合操作时间短、直线器械吻合的吻合口狭窄发生率低等：而手工吻合作为传统的食管胃吻合方式，操作灵活机动、缝合可靠，为胸外科医生的必备技能；另外，新型食管癌微创技术的开展，如机器人辅助食管癌手术增强了手工吻合的操作性和效率，具有良好的应用前景。总体来说，各吻合方式的术后病死率无明显区别，因吻合方式不同导致的吻合口漏发生率的比较则需要进一步的大型临床研究验证。外科医生面对不同病例选择何种吻合方式，均需结合病例的自身特点及医生自身的技术掌握熟练程度，以减少吻合口并发症为目标，使患者最大获益。Intrathoracic esophagogastric anastomosis is the mainstay of esophageal reconstruction after esophagectomy for the middle and lower esophageal cancer, which is the majority of esophageal cancer. In spite of the constant development of techniques and instruments for esophageal reconstruction, incidence of anastomotic complications stays high, including anastomotic leak and stricture. The current common esophagogastric anastomosis primarily consists of hand-sewn anastomosis and stapled anastomosis. This review presented different ways of intrathoracic esophagogastric anastomosis in reference to the literatures in China and abroad, and comparisons and analyses were made according to operative techniques, anastomotic complication rates, postoperative mortality rates, etc. The results demonstrated that various anastomotic methods had individual, advantages and disadvantages. Duration of stapled anastomosis is short, and linear-stapled anastomosis has a low incidence of anastomotic stricture. Traditional hand-sewn anastomosis, as a necessary skill for thoracic surgeons, shows great manipulative flexibility and reliability. Moreover, the advances in minimally invasive esophageal surgery, such as robot- assisted esophagectomy, increases the operability and efficiency of hand-sewn anastomosis with a promising perspective. In general, among diverse anastomotic methods, mortality does not differ, and the comparison of anastomotic leak rates requires further large clinical trials. Thoracic surgeons have to decide on the anastomotic method of every single case based on patient characteristics and technical proficiency, with the final aim of minimizing anastomotic complications and maximizing patient benefits.

关 键 词：食管肿瘤 外科手术 食管胃吻合 胸内吻合 

分 类 号：R735.1[医药卫生—肿瘤]