Toyota Satoshi, Kimura Yasue, Jogo Tomoko, Hu Qingjiang, Hokonohara Kentaro, Nakanishi Ryota, Hisamatsu Yuichi, Ando Koji, Oki Eiji, Mori Masaki
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Surg Laparosc Endosc Percutan Tech. 2021 Jan 22;31(4):453-456. doi: 10.1097/SLE.0000000000000899.
Various techniques have been reported for esophagogastric anastomosis to prevent anastomotic leakage. Recently, not only postoperative anastomotic leakage but also anastomotic stricture is considered important because stricture contributes to the patient's postoperative quality of life. However, the best procedure for anastomosis has not been established.
The authors divided 101 patients with thoracic or abdominal esophageal cancer who underwent cervical triangulating esophagogastric anastomosis using a linear stapler between May 2017 and May 2020 into 2 groups: surgery with a short (45 mm) linear stapler (SS group, n=59) or a long (60 mm) stapler (LS group, n=42). The frequencies of anastomotic leakage and stricture were compared between the 2 groups.
The incidence of anastomotic leakage and stricture without leakage were significantly lower in the LS versus SS group (respectively: leakage: 15% vs. 0%, P=0.01; stricture: 36% vs. 7%, P=0.01). A short linear stapler and anastomotic leakage were independent risk factors for anastomotic stricture in the multivariate analysis (short stapler: odds ratio, 3.27; 95% confidence interval, 1.08-9.9; P=0.03; anastomotic leakage: odds ratio, 2.78; 95% confidence interval, 1.02-8.5; P=0.04).
A long linear stapler is preferable for cervical triangulating esophagogastric anastomosis.
已有多种食管胃吻合技术被报道用于预防吻合口漏。近来，不仅术后吻合口漏，而且吻合口狭窄也被认为很重要，因为狭窄会影响患者术后的生活质量。然而，最佳的吻合手术方法尚未确立。
作者将2017年5月至2020年5月期间接受使用直线切割吻合器进行颈部三角形食管胃吻合术的101例胸段或腹段食管癌患者分为两组：使用短（45毫米）直线切割吻合器的手术组（SS组，n = 59）和使用长（60毫米）吻合器的手术组（LS组，n = 42）。比较两组之间吻合口漏和狭窄的发生率。
LS组吻合口漏及无漏情况下狭窄的发生率显著低于SS组（分别为：漏：15%对0%，P = 0.01；狭窄：36%对7%，P = 0.01）。在多因素分析中，短直线切割吻合器和吻合口漏是吻合口狭窄的独立危险因素（短吻合器：比值比，3.27；95%置信区间，1.08 - 9.9；P = 0.03；吻合口漏：比值比，2.78；95%置信区间，1.02 - 8.5；P = 0.04）。
对于颈部三角形食管胃吻合术，长直线切割吻合器更可取。
