Fok M, Ah-Chong A K, Cheng S W, Wong J
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Br J Surg. 1991 Mar;78(3):342-5. doi: 10.1002/bjs.1800780323.
A total of 611 patients with carcinoma of the oesophagus or gastric cardia were operated on between July 1982 and December 1989. Resection was performed in 491 patients (one-stage, 483; two-stage, eight), bypass operation in 97, and 23 had exploration alone. The anastomoses of 580 patients with one-stage resection and bypass operations were evaluated. Hand-sewn anastomosis using a single layer of continuous absorbable monofilament suture was performed in 304 patients (221 resections and 83 bypasses). A stapled anastomosis was performed on 276 patients (262 resections and 14 bypasses). Following resection, there were 11 (5 per cent) anastomotic leaks in the hand-sewn group and ten (3.8 per cent) in the stapled anastomosis group (P = 0.69). Excluding anastomotic leaks, hospital mortality and anastomotic recurrence, stricture occurred in 18 of 172 hand-sewn anastomoses (10.5 per cent) and in 57 of 195 stapled anastomoses (29.2 per cent) (P less than 0.001). In patients who had bypass operations there were 12 anastomotic leaks, ten in the hand-sewn group (12.0 per cent) and two in the stapled anastomosis group (14.3 per cent). Only two of the discharged patients with bypass developed anastomotic strictures, a low incidence probably because of short survival. In addition, there were 245 subsidiary anastomoses made in the abdomen by the hand-sewn method as part of the reconstructive procedure, and there was one leak. The results of this non-randomized study suggest that hand-sewn anastomosis using a single layer continuous technique for the oesophagus is as safe as the use of circular staplers; hand-sewn anastomosis is less likely to become stenotic.
1982年7月至1989年12月期间，共有611例食管癌或贲门癌患者接受了手术治疗。491例患者进行了切除手术（一期手术483例，二期手术8例），97例患者进行了旁路手术，23例患者仅进行了探查。对580例行一期切除和旁路手术患者的吻合情况进行了评估。304例患者（221例切除手术和83例旁路手术）采用单层连续可吸收单丝缝线进行手工缝合吻合。276例患者（262例切除手术和14例旁路手术）进行了吻合器吻合。切除术后，手工缝合组有11例（5%）吻合口漏，吻合器吻合组有10例（3.8%）（P = 0.69）。排除吻合口漏、医院死亡率和吻合口复发情况，172例手工缝合吻合中有18例（10.5%）发生狭窄，195例吻合器吻合中有57例（29.2%）发生狭窄（P＜0.001）。接受旁路手术的患者中有12例吻合口漏，手工缝合组10例（12.0%），吻合器吻合组2例（14.3%）。旁路手术出院患者中只有2例发生吻合口狭窄，发生率较低，可能是因为生存期短。此外，作为重建手术的一部分，通过手工缝合方法在腹部进行了245例辅助吻合，有1例发生漏。这项非随机研究结果表明，食管单层连续技术手工缝合吻合与使用圆形吻合器一样安全；手工缝合吻合发生狭窄的可能性较小。
