Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
West China Biomedical Big Data Center, West China Hospital of Sichuan University, No. 37, Guo Xue Xiang, Chengdu, China.
World J Surg. 2017 Dec;41(12):3164-3170. doi: 10.1007/s00268-017-4126-0.
Anastomotic leakage and stricture contribute to a large number of mortality and morbidity after esophagectomy. The aim of this work is to evaluate the outcome of modified double-layer hand-sewn esophagogastric anastomosis during minimally invasive esophagectomy for esophageal cancer.
The clinicopathological data of 176 consecutive esophageal cancer patients who underwent cervical esophagogastric anastomosis using modified double-layer hand-sewn technique after radical esophagectomy were retrospectively reviewed. Total minimally invasive approach, including thoracoscopic surgery for thoracic procedure and laparoscopic approach for abdominal procedure, was implemented during the radical Mckeown esophagectomy. Patients were followed up for the assessment of postoperative anastomotic complications including anastomotic leakage and stricture, being the primary outcome measures for this study.
Anastomotic leakage occurred in 2 of 176 patients (1.1%); both of the patients experienced only minor leakage and were treated conservatively. There was no significant difference in leakage between patients with and without major comorbidity (p = 0.331). After a mean follow-up of 21.3 months, four patients (4/176, 2.3%) developed benign anastomotic strictures, including those 2 patients experienced postoperative leakage. Symptoms for stricture were improved by endoscopic dilatations in all 4 patients. Besides, there was one case (1/176, 0.6%) of gastric necrosis in this cohort, who was also successfully managed by conservative therapy with no operative mortality.
This modified double-layer hand-sewn anastomosis is a highly safe and stable technique for esophagogastrostomy, which is an effective way to prevent both anastomotic leakage and stricture.
吻合口漏和狭窄是食管癌手术后大量患者死亡和发病的主要原因。本研究旨在评估改良双层手工食管胃吻合术在微创食管癌根治术中的应用效果。
回顾性分析 176 例接受根治性微创 McKeown 食管癌切除术后采用改良双层手工食管胃吻合术的食管癌患者的临床病理资料。根治性手术采用全微创方法，包括胸腔镜下进行胸段手术和腹腔镜下进行腹部手术。术后评估吻合口并发症，包括吻合口漏和狭窄，将其作为本研究的主要观察指标。
176 例患者中有 2 例（1.1%）发生吻合口漏，均为轻度漏，经保守治疗后痊愈。有和无严重合并症的患者之间吻合口漏的发生率无显著差异（p=0.331）。平均随访 21.3 个月后，4 例（4/176，2.3%）患者发生良性吻合口狭窄，其中 2 例为术后漏患者。所有 4 例患者均通过内镜扩张改善了狭窄症状。此外，该队列中有 1 例（1/176，0.6%）胃坏死患者，经保守治疗成功，无手术死亡。
改良双层手工吻合术是一种安全、稳定的食管胃吻合技术，可有效预防吻合口漏和狭窄。
