Campion J P, Nomikos J, Launois B
Department of Surgery, Rennes University of Medicine, France.
Arch Surg. 1988 Aug;123(8):979-83. doi: 10.1001/archsurg.1988.01400320065013.
Two hundred fifty patients with cancer underwent gastrectomy over a ten-year period. In 225 the duodenum was closed by stapler and only one disruption occurred (0.45%). The first 89 esophagojejunostomies were hand sewn, and thereafter 161 were stapled with an end-to-end anastomosis device. Overall mortality was 27% and 10%, respectively. Death due to surgical causes occurred in 19% of the cases in the first group and 6.8% in the second. No statistical difference was observed in the esophageal anastomosis leakage rate, but the mortality due to such fistula was significantly higher in the group of hand-sewn anastomoses. Surprisingly, esophageal end invasion (at the anastomotic site) was 14% in the manual group vs 3.9% in the stapled one. The operator's experience had no effect on the incidence of esophageal fistula when the stapler was used. Thus, staplers are safe and useful when total gastrectomy is undertaken, provided that sound experience has been acquired.
在十年期间，250例癌症患者接受了胃切除术。其中225例患者的十二指肠用吻合器闭合，仅发生1例破裂（0.45%）。最初的89例食管空肠吻合术采用手工缝合，此后161例采用端端吻合器吻合。总体死亡率分别为27%和10%。第一组因手术原因导致的死亡占19%，第二组为6.8%。食管吻合口漏率未见统计学差异，但手工缝合吻合组因这种瘘导致的死亡率显著更高。令人惊讶的是，手工缝合组食管端侵犯（在吻合部位）为14%，而吻合器吻合组为3.9%。使用吻合器时，术者经验对食管瘘的发生率没有影响。因此，在进行全胃切除术时，只要积累了丰富的经验，吻合器是安全且有用的。
