Kitayama J, Kaisaki S, Ishigami H, Hidemura A, Nagawa H
Department of Surgical Oncology, The University of Tokyo, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
Dis Esophagus. 2009;22(5):418-21. doi: 10.1111/j.1442-2050.2008.00920.x. Epub 2009 Jan 13.
Anastomotic leakage after radical esophagectomy is mostly caused by the hypoxia and high tension at the esophagogastric anastomotic site. Here, we introduce a new surgical technique, 'Angleplasty,' to enable the tensionless anastomosis at a highly oxygenic site of gastric conduit. In short, the seromuscular layer is cut for a perpendicular direction against a lesser curvature at a gastric angle and the gastric wall is carefully divided between the muscular and submucosal layers for longitudinal direction for 4-5 cm in length. Then, the wound is closed with seromuscular sutures for longitudinal direction. With this maneuver, the lesser curvature of the gastric roll is significantly elongated and the anastomosis site of the gastric conduit can be moved more distal on the greater curvature of the stomach where it is expected to receive more oxygen supply. This technique takes only several minutes, but provides highly favorable conditions for esophagogastric anastomosis and thus is clinically useful to reduce the risk of anastomotic leakage after esophagectomy.
根治性食管切除术后吻合口漏主要是由食管胃吻合部位的缺氧和高张力引起的。在此，我们介绍一种新的手术技术——“角成形术”，以使胃管在高氧部位进行无张力吻合。简而言之，在胃角处沿与小弯垂直的方向切开浆肌层，并在肌肉层和黏膜下层之间沿纵向小心地分离胃壁4-5厘米长。然后，用纵向的浆肌层缝线关闭伤口。通过这种操作，胃卷的小弯明显延长，胃管的吻合部位可以在胃大弯上更向远端移动，预计在该部位能获得更多的氧气供应。该技术仅需几分钟，但为食管胃吻合提供了非常有利的条件，因此在临床上对于降低食管切除术后吻合口漏的风险是有用的。
