Deng Bo, Wang Ru-Wen, Jiang Yao-Guang, Tan Qun-You, Zhao Yun-Ping, Zhou Jing-Hai, Liao Xiang-Li, Ma Zheng
Thoracic Surgery Department, Daping Hospital, Third Military Medical University, Chongqing City 400042, PR China.
Eur J Cardiothorac Surg. 2009 Jan;35(1):8-12. doi: 10.1016/j.ejcts.2008.09.008. Epub 2008 Oct 9.
In the study, we made the pharyngoesophageal functional assessment and menometric study on the two kinds of anastomosis (traditional hand-sewn anastomosis and side-to-side stapled anastomosis) for the further evaluation and application of cervical esophagogastrostomy.
The study included 17 patients with esophageal squamous cancer from March 2006 to May 2008. Eight patients had undergone total esophagectomy and traditional hand-sewn technique in CEGA. The other nine patients had undergone total esophagectomy and side-to-side stapled technique in CEGA. All the 17 patients were studied for 3 months after the operations. The complete data, such as esophagogastroscopy, barium swallow and manometric studies, were obtained for each participating patient.
In the hand-sewn group of eight patients, four patients (50%) reported clinical significant symptoms of cervical dysphagia. Two patients (11.1%) reported clinical significant symptoms of cervical dysphagia in the side-to-side group of nine patients. There is a statistically significant difference between the hand-sewn group of patients (n=8) and the side-to-side group of patients (n=9) with respect to overall mean anastomotic diameters (1.688+/-0.26 cm vs 3.012+/-0.17 cm, p=2.10 x 10(-8)). In the eight patients who underwent hand-sewn technique, there were four symptomatic patients with poor menometric datum, such as anastomotic hypertensive peristaltic activity, confusing inversion of anastomotic and midcervical esophageal pressure, and consequently poor compliance of the pharyngoesophageal segment (pharyngeal shoulder pressure). By contrast, there was only one symptomatic patient with poor menometric data in the nine patients who underwent side-to-side technique.
The side-to-side stapled technique is conducive to decrease complications of postoperative dysphagia and is helpful for improving pharyngesophageal and anastomotic menometric function. The anastomotic technique deserves more attention and further applications.
在本研究中，我们对两种吻合方式（传统手工缝合吻合和侧侧吻合器吻合）进行了咽食管功能评估和测压研究，以进一步评估和应用颈段食管胃吻合术。
本研究纳入了2006年3月至2008年5月期间的17例食管鳞癌患者。8例患者接受了全食管切除术并采用传统手工缝合技术进行颈段食管胃吻合术（CEGA）。另外9例患者接受了全食管切除术并采用侧侧吻合器技术进行CEGA。所有17例患者在术后均接受了3个月的研究。为每位参与研究的患者获取了完整的数据，如食管胃镜检查、吞钡检查和测压研究结果。
在8例手工缝合组患者中，4例（50%）报告有临床显著的颈部吞咽困难症状。在9例侧侧吻合组患者中，2例（11.1%）报告有临床显著的颈部吞咽困难症状。手工缝合组患者（n = 8）和侧侧吻合组患者（n =
9）的总体平均吻合口直径存在统计学显著差异（1.688±0.26 cm对3.012±0.17 cm，p = 2.10×10⁻⁸）。在接受手工缝合技术的8例患者中，有4例有症状患者的测压数据不佳，如吻合口高压蠕动活动、吻合口和颈段食管中段压力的混淆反转，以及因此导致的咽食管段顺应性差（咽肩部压力）。相比之下，在接受侧侧吻合技术的9例患者中，只有1例有症状患者测压数据不佳。
侧侧吻合器技术有助于减少术后吞咽困难的并发症，并有助于改善咽食管和吻合口的测压功能。该吻合技术值得更多关注和进一步应用。
