食管癌切除颈部食管胃侧侧吻合术(附18例报道)
Esophagectomy and Cervical Side-to-side Esophagogastric Anastomosis in the Treatment of Esophageal Cancer: a Report of 18 Cases
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摘要: 目的: 探讨食管癌切除、颈部食管胃侧侧吻合术的治疗效果及应用前景。 方法: 18例中上段食管癌患者行食管癌切除、颈部食管胃侧侧吻合术,并对其临床资料进行回顾性分析。术中按肿瘤手术切除原则常规游离食管及近端胃,切除肿瘤,将胃缝缩成管型;取颈部切口,暴露并游离颈段食管;根据手术切口的不同,采取不同径路将管型胃经食管床上提至颈部,将管型胃与颈段食管重叠约5cm,在胃前壁距胃底约5cm处戳一小口,将食管断端切成前长后短的斜行,将切割缝合器的钉槽插入胃内、钉仓插入食管腔,击发缝合并切割,将食管斜行断端与管型胃前壁缝合,形成长约3cm的吻合口;管型胃顶端固定于吻合口上方的颈椎前筋膜,完成颈部食管胃侧侧吻合。 结果: 本组病例术后分期分别为Ⅱa期(4例)、Ⅱb期(9例)、Ⅲ期(5例)。手术径路分别为不开胸颈腹两切口(8例)、右胸颈腹三切口(9例)、左胸颈两切口(1例)。全部病例均手术顺利,术后出现吻合口瘘1例,发生率为5.56%,颈部引流、禁食2周后治愈;全部病例出院前复查上消化道钡透均见吻合口通畅、无狭窄,术后随诊1～5年不等,均未见吻合口狭窄,但有2例患者出现返流性食管炎症状,发生率为11.11%。 结论: 颈部食管胃侧侧吻合术可有效预防术后吻合口并发症的发生,值得临床推广。Abstract: Objective: To investigate the clinical application and effects of esophagectomy and cervical side-to-side esophagogastric anastomosis in the treatment of esophageal cancer. Methods: The clinical data from 18 patients with esophageal carcino-ma who underwent esophagectomy and cervical side-to-side esophagogastric anastomosis were retrospectively analyzed.The average age of these patients was 60.7 years and the male-to-female ratio was 17:1.The tumors were located in the upper part of the esophagus in 4 cases and in the middle thoracic part in 14 cases.The tumors were 1 to 7 cm in length, with an average of 3.2cm.The surgical procedures included total esophagectomy, gastric tube construction and cervical side-to-side esophagogastric anastomosis.After esophagectomy, the gastric tube was formed and pulled up to the left cer-vical area through the posterior mediastinum.The posterior wall of the divided esophagus was aligned to the anterior wall of the gastric fundus for approximately 5cm.A 5cm gastrotomy was made on the anterior gastric wall to the gastric fundus.The side-to-side esophagogastric anastomosis was done with a 45mm endo-GIA stapler.The closure of the anterior anas-tomosis was implemented by stitching within the hood of the overlying wall of the esophagus. Results: The postoperative staging was as follows: 4 stage IIa cases, 9 stage IIb cases and 5 stage Ⅲ cases.Eight cases had non-transthoracic cervi-cal and abdominal double incisions, 9 cases had right cervico-thoraco-abdominal triple incisions and 1 case had left cer-vico-thoracic incision.Anastomotic leakage was observed in 1 case and was cured in two weeks by cervical drainage and restricted diet.All of the 18 cases were followed up for 1 to 5 years.No anastomotic stricture was seen.Reflux esophagitis was found in 2 cases, with an incidence rate of 11.11%. Conclusion: Cervical side-to-side esophagogastric anastomosis is a safe procedure.With larger resection margins and a lower incidence of anastomosis-related complications, this tech-nique is worthy of wide clinical application.
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