Henriques Alexandre Cruz, Zanon Aline Biral, Godinho Carlos Alberto, Martins Lourdes Conceição, Saad Junior Roberto, Speranzini Manlio Basilio, Waisberg Jaques
Disciplina do Aparelho Digestivo da Faculdade de Medicina do ABC - São Bernardo do Campo - SP - BR.
Rev Col Bras Cir. 2009 Oct;36(5):398-405. doi: 10.1590/s0100-69912009000500007.
To assess the incidence of fistula and stenosis of cervical esophagogastric anastomosis with invagination of the esophageal stump into the gastric tube in esophagectomy for esophagus cancer.
Two groups of patients with thoracic and abdominal esophagus cancer undergoing esophagectomy and esophagogastroplasty were studied. Group I comprised 29 patients who underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump segment within the stomach, in the period of 1998 to 2007 while Group II was composed of 36 patients submitted to end-to-end cervical esophago-gastric anastomosis without invagination during the period of 1989 to 1997.
In Group I, esophagogastric anastomosis by invagination presented fistula with mild clinical implications in 3 (10.3%) patients, whereas in Group II, fistulas with heavy saliva leaks were observed in 11 (30.5%) patients. The frequency of fistulas was significantly lower in Group I patients (p=0.04) than in Group II. In Group I, fibrotic stenosis of anastomoses occurred in 7 (24.1%) subjects, and 10 patients (27.7%) in Group II evolved with stenosis, while no significant difference (p=0.72) was found between the two groups.
In esophagectomy for esophagus cancer, cervical esophagogastric anastomosis with invagination presented a lower rate of esophagogastric fistula versus anastomosis without invagination. Stenosis rates in esophagogastric anastomosis proved similar in both approach with or without invagination.
评估食管癌切除术中采用食管残端内翻入胃管的颈段食管胃吻合术时瘘管和狭窄的发生率。
对两组行食管癌切除术及食管胃成形术的胸段和腹段食管癌患者进行研究。第一组包括1998年至2007年期间接受颈段食管胃吻合术且近端食管残端段内翻入胃内的29例患者，而第二组由1989年至1997年期间接受无内翻的端端颈段食管胃吻合术的36例患者组成。
在第一组中，内翻式食管胃吻合术有3例（10.3%）患者出现具有轻度临床影响的瘘管，而在第二组中，观察到11例（30.5%）患者出现伴有大量唾液漏的瘘管。第一组患者的瘘管发生率显著低于第二组（p=0.04）。在第一组中，7例（24.1%）患者发生吻合口纤维化狭窄，第二组中有10例（27.7%）患者出现狭窄，两组之间未发现显著差异（p=0.72）。
在食管癌切除术中，与无内翻的吻合术相比，采用内翻的颈段食管胃吻合术的食管胃瘘发生率较低。食管胃吻合术的狭窄发生率在有内翻和无内翻两种方法中相似。
