一种用于食管癌手术治疗的新型三层漏斗形食管胃吻合术。

A new three-layer-funnel-shaped esophagogastric anastomosis for surgical treatment of esophageal carcinoma.

作者信息

Dan Han-Lei, Bai Yang, Meng Hui, Song Cong-Lin, Zhang Jie, Zhang Yong, Wan Lei-Chi, Zhang Ya-Li, Zhang Zhen-Shu, Zhou Dian-Yuan

机构信息

Research Institute of Digestive Disease, South Hospital, First Military Medical University, Guangzhou 510515, Guangdong Province, China.

出版信息

World J Gastroenterol. 2003 Jan;9(1):22-5. doi: 10.3748/wjg.v9.i1.22.

DOI:10.3748/wjg.v9.i1.22

PMID:12508344

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4728241/

Abstract

AIM

To reduce the incidence of postoperative anastomotic leak, stenosis, gastroesophageal reflux (GER) for patients with esophageal carcinoma, and to evaluate the conventional method of esophagectomy and esophagogastroplasty modified by a new three-layer-funnel-shaped (TLF) esophagogastric anastomotic suturing technique.

METHODS

From January 1997 to October 1999, patients with clinical stage I and II (IIa and IIb) esophageal carcinoma, which met the enrollment criteria, were surgically treated by the new method (Group A) and by conventional operation (Group B). All the patients were followed at least for 6 months. Postoperative outcomes and complications were recorded and compared with the conventional method in the same hospitals and with that reported previously by McLarty et al in 1997 (Group C).

RESULTS

58 cases with stage I and II (IIa and IIb) esophageal carcinoma, including 38 males and 20 females aged from 34 to 78 (mean age: 57), were surgically treated by the TLF anastomosis and 64 by conventional method in our hospitals from January 1997 to October 1999. The quality of swallowing was improved significantly (Wilcoxon W=2 142, P=0.0 001) 2 to 3 months after the new operation in Group A. Only one patient had a blind anastomatic fistula diagnosed by barium swallow test 2 months but healed up 3 weeks later. Postoperative complications occurred in 25 (43 %) patients, anastomotic stenosis in 8 (14 %), and GER in 13 (22 %). The incidences of postoperative anastomotic leak, stenosis and GER were significantly decreased by the TLF anastomosis method compared with that of conventional methods (chi(2)=6.566, P=0.038; chi(2)=10.214, P=0.006; chi(2)=21.265, P=0.000).

CONCLUSION

The new three-layer-funnel-shaped esophagogastric anastomosis (TLFEGA) has more advantages to reduce postoperative complications of anastomotic leak, stricture and GER.

摘要

目的

降低食管癌患者术后吻合口漏、狭窄及胃食管反流（GER）的发生率，并评估采用新型三层漏斗形（TLF）食管胃吻合缝合技术改良的传统食管癌切除术及食管胃成形术。

方法

1997年1月至1999年10月，符合入选标准的临床Ⅰ期和Ⅱ期（Ⅱa和Ⅱb）食管癌患者，分别采用新方法（A组）和传统手术方法（B组）进行手术治疗。所有患者至少随访6个月。记录术后结果及并发症，并与同医院的传统方法以及McLarty等人1997年报道的结果（C组）进行比较。

结果

1997年1月至1999年10月，我院采用TLF吻合术治疗Ⅰ期和Ⅱ期（Ⅱa和Ⅱb）食管癌患者58例，其中男性38例，女性20例，年龄34至78岁（平均年龄：57岁）；采用传统方法治疗64例。A组新手术后2至3个月吞咽质量显著改善（Wilcoxon W = 2142，P = 0.0001）。仅1例患者术后2个月经吞钡试验诊断为盲端吻合口瘘，但3周后愈合。术后25例（43%）发生并发症，8例（14%）出现吻合口狭窄，13例（22%）出现GER。与传统方法相比，TLF吻合术可显著降低术后吻合口漏、狭窄及GER的发生率（χ² = 6.566，P = 0.038；χ² = 10.214，P = 0.006；χ² = 21.265，P = 0.000）。