Krolevets I P, Demin D I
Khirurgiia (Mosk). 1994 Mar(3):13-6.
Incompetence of esophageal anastomoses and reflux esophagitis are frequent complications occurring after gastrectomy and proximal resection of the stomach. The authors examined 149 persons who underwent operations for carcinoma of the stomach and lower third of the esophagus. In a group of 47 patients who underwent gastrectomy or proximal resection of the stomach with the formation of the ordinary not areflux anastomoses, nine died from incompetence of the sutures. In study of the late-term results gastroduodenoscopy revealed reflux esophagitis in 22 persons. Intraesophageal pH measurement showed values of 2.0 to 3.0. In 20 patients of this group piezo-resonance manometry demonstrated an essential unfavorable feature of the intraluminal pressure gradient--the intraluminal pressure was lower in the esophagus than in the stomach stump anastomosed with it or in the loop of the small intestine. This facilitated the development of reflux esophagitis. The authors developed a method of invagination areflux esophageal anastomosis by the closed techniques with the use of laser. The anastomosis is formed by two continuous sutures of a synthetic absorbable thread with an autraumatic needle. Incompetence of the sutures occurred in two patients. Piezoresonance manometry revealed a zone of increased intraluminal pressure in the region of the esophageal anastomosis. Mild reflux esophagitis was encountered in three patients. The authors recommend a new modification of esophageal anastomosis for surgical practice.
食管吻合口功能不全和反流性食管炎是胃切除术后及胃近端切除术后常见的并发症。作者对149例因胃癌和食管下三分之一癌接受手术的患者进行了检查。在一组47例行胃切除术或胃近端切除术并形成普通非反流吻合口的患者中，9例死于缝线功能不全。在对远期结果的研究中，胃十二指肠镜检查发现22人患有反流性食管炎。食管内pH值测量显示为2.0至3.0。在该组的20例患者中，压电共振测压显示管腔内压力梯度存在一个重要的不利特征——食管内的管腔内压力低于与之吻合的胃残端或小肠袢内的压力。这促进了反流性食管炎的发展。作者开发了一种使用激光通过闭合技术进行套叠式抗反流食管吻合的方法。吻合口由两根连续的合成可吸收线和无创伤针缝合而成。有2例患者出现缝线功能不全。压电共振测压显示食管吻合口区管腔内压力升高。3例患者出现轻度反流性食管炎。作者推荐一种新的食管吻合改良方法用于外科手术实践。
