Akiyama Y, Iwaya T, Endo F, Shioi Y, Chiba T, Takahara T, Otsuka K, Nitta H, Koeda K, Mizuno M, Kimura Y, Sasaki A
Department of Surgery.
Department of Palliative Medicine, Iwate Medical University School of Medicine, Iwate, Japan.
Dis Esophagus. 2017 May 1;30(5):1-7. doi: 10.1093/dote/dow007.
The aim of the present study is to evaluate the outcome of hand-sewn esophagogastric anastomosis during radical esophagectomy for esophageal cancer. The outcomes of 467 consecutive esophageal cancer patients who underwent cervical esophagogastric anastomosis using interrupted and double-layered sutures after radical esophagectomy via right thoracotomy or thoracoscopic surgery were retrospectively reviewed. Anastomotic leakage, including conduit necrosis, occurred in 11 of 467 patients (2.4%); 7 of 11 (63.6%) cases experienced only minor leakage, whereas the other four (36.4%) patients had major leakage that required surgical or radiologic intervention, including two patients of conduit necrosis. Anastomotic leakages were more frequently observed after retrosternal reconstruction compared with the posterior mediastinal route (P < 0.0001). The median time to healing of leakage was 40 days (range: 14-97 days). Two patients (2/467, 0.4%) died in the hospital due to sepsis caused by the leakage and conduit necrosis. Twelve patients (2.6%) developed anastomotic stenosis, which was improved by dilatation in all patients. Hand-sewn cervical esophagogastric anastomosis is a stable and highly safe method of radical esophagectomy for esophageal cancer.
本研究的目的是评估食管癌根治性食管切除术中手工缝合食管胃吻合术的效果。回顾性分析了467例连续性食管癌患者的手术结果，这些患者在右胸开胸或胸腔镜手术根治性食管切除术后，采用间断双层缝合进行颈部食管胃吻合术。467例患者中有11例（2.4%）发生吻合口漏，包括管道坏死；11例中的7例（63.6%）仅出现轻微漏，而另外4例（36.4%）患者发生严重漏，需要手术或放射学干预，其中2例为管道坏死。与后纵隔途径相比，胸骨后重建术后吻合口漏的发生率更高（P<0.0001）。漏口愈合的中位时间为40天（范围：14 - 97天）。2例患者（2/467，0.4%）因漏口和管道坏死引起的败血症在医院死亡。12例患者（2.6%）发生吻合口狭窄，所有患者均通过扩张得到改善。手工缝合颈部食管胃吻合术是一种稳定且安全性高的食管癌根治性食管切除方法。
