Fujioka Masaki, Taniguchi Ken, Yoneda Akira, Fukui Kiyoko, Yoshino Kentaro, Idemitsu Marie
Department of Plastic and Reconstructive Surgery, Nagasaki University, Nagasaki, Japan.
Department of Plastic and Reconstructive Surgery, Clinical Research Center, National Hospital Organization, Nagasaki Medical Center, Nagasaki, Japan.
JTCVS Tech. 2023 Mar 16;19:142-146. doi: 10.1016/j.xjtc.2023.03.005. eCollection 2023 Jun.
Gastric pull-up is a common procedure to reconstruct the continuity of the upper digestive tract after esophagectomy. However, this technique sometimes causes postoperative anastomotic leakage or stricture, resulting from congestion of the gastric tube. We performed additional microvascular venous anastomoses to solve this problem. The purpose of this study was to compare postoperative anastomotic leaks and strictures in cases with or without additional venous superdrainage after gastric tube reconstruction.
A total of 117 consecutive patients with cervical and thoracic esophageal cancer who underwent thoracoscopic esophagectomy with gastric tube reconstruction in the National Nagasaki Medical Center between 2011 and 2021 were analyzed retrospectively. Of these patients, 46 did not undergo additional venous anastomoses (standard group), and 71 who underwent gastric pull-up surgery after November 2014 have added this surgical procedure to their routine (superdrainage group). We compared the frequency of postsurgical leakage and stricture in the 2 groups retrospectively.
Fifteen patients (32.6%) developed postoperative leakage in the standard group and 6 (8.5%) did so in the superdrainage group. Twelve patients (26.1%) showed postoperative anastomotic stricture in the standard group and 7 (9.9%) did so in the superdrainage group. Patients who did not undergo additional venous superdrainage were significantly more likely to develop postsurgical leakage (χ test < .01) and anastomotic stricture (χ test < .05). The mean time taken to perform additional venous anastomoses was 54.2 minutes.
Our study revealed that performing additional venous anastomosis for as little as 1 hour can significantly reduce the incidence of postoperative leakage and stenosis. This procedure is of merit to perform after total esophagectomy with gastric tube reconstruction.
胃上提术是食管癌切除术后重建上消化道连续性的常用手术。然而，该技术有时会因胃管充血导致术后吻合口漏或狭窄。我们进行了额外的微血管静脉吻合术来解决这个问题。本研究的目的是比较胃管重建后有或没有额外静脉引流的病例术后吻合口漏和狭窄的情况。
回顾性分析2011年至2021年期间在长崎国立医疗中心接受胸腔镜食管癌切除术并进行胃管重建的117例连续性颈段和胸段食管癌患者。在这些患者中，46例未进行额外的静脉吻合（标准组），71例在2014年11月后接受胃上提手术的患者将此手术添加到了常规手术中（引流组）。我们回顾性比较了两组术后漏和狭窄的发生率。
标准组有15例患者（32.6%）发生术后漏，引流组有6例（8.5%）。标准组有12例患者（26.1%）出现术后吻合口狭窄，引流组有7例（9.9%）。未进行额外静脉引流的患者发生术后漏（χ检验<0.01）和吻合口狭窄（χ检验<0.05）的可能性显著更高。进行额外静脉吻合的平均时间为54.2分钟。
我们的研究表明，仅进行1小时的额外静脉吻合就能显著降低术后漏和狭窄的发生率。该手术在全食管切除并进行胃管重建后进行是有价值的。
