Sun Y, Ding B, Zhou N
Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, China.
Chin Med J (Engl). 1998 Oct;111(10):867-9.
To investigate the safety and efficacy of mechanical anastomosis with Chinese staplers in the surgical treatment of esophageal carcinoma and carcinoma of gastric cardia in order to find out an alternative effective anastomotic technique to hand-sewn method.
From August 1980 to April 1996, there were totally 1264 cases of esophageal carcinoma and 701 cases of carcinoma of gastric cardia receiving esophagogastric anastomosis with Chinese staplers combined with telescope suturing of seromuscular layers after resection of tumors, with age ranging from 28 years to 81 years and a man to woman ratio of 4:1 (1572/393). The anastomosis was performed at the cervical region in 44 patients, and intrathoracically in 1921. Our technical essential points also included fixation of the gastric substitute to the thoracic apex or mediastinum with 3-4 stitches to relieve the anastomotic tension.
Compared with the reported postoperative leakage rate from 2%-4% in China and 4.2%-12.3% abroad, our techniques reduced the total leakage rate to 0.8%, that is, cervical leakage rate was 11.4% (5/44), and intrathoracic leakage rate 0.57% (11/1921). The intrathoracic leakage rate was 0.99% (8/808) for the first 8 years, and 0.27% for the following 8 years. There was no leakage (0/350) in the last 3 years. There anastomotic stricture occurred in 98 patients (4.99%) which could be relieved by Bougie or balloon dilatation. The total operative mortality was reduced to 0.76%.
Mechanical anastomosis with Chinese staplers combined with telescope suturing should be an effective method to prevent the occurrence of anastomotic leakage after esophageal resections.
探讨国产吻合器机械吻合在食管癌和贲门癌手术治疗中的安全性和有效性，以寻找一种替代手工缝合的有效吻合技术。
1980年8月至1996年4月，共有1264例食管癌和701例贲门癌患者在肿瘤切除后采用国产吻合器行食管胃吻合，并加做浆肌层包埋缝合，年龄28岁至81岁，男女比例为4∶1（1572/393）。44例在颈部吻合，1921例在胸内吻合。技术要点还包括用3至4针将胃代食管固定于胸顶或纵隔以减轻吻合口张力。
与国内报道的术后吻合口漏发生率2％～4％及国外报道的4.2％～12.3％相比，我们的技术使总漏率降至0.8％，即颈部漏率为11.4％（5/44），胸内漏率为0.57％（11/1921）。前8年胸内漏率为0.99％（8/808），后8年为0.27％。最近3年无漏发生（0/350）。98例（4.99％）发生吻合口狭窄，可用探条或气囊扩张解除。总手术死亡率降至0.76％。
国产吻合器机械吻合加包埋缝合应是预防食管切除术后吻合口漏发生的有效方法。
