Zieren H U, Müller J M, Pichlmaier H
Department of Surgery, University of Cologne, Germany.
Br J Surg. 1993 May;80(5):608-11. doi: 10.1002/bjs.1800800519.
In a prospective randomized study, one- and two-layer anastomoses were compared following subtotal oesophagectomy and gastric substitution with cervical oesophagogastric anastomosis. After 54 one- and 53 two-layer procedures the rates of anastomotic leakage were the same (19 per cent). After a mean follow-up of 44 weeks, 13 of 51 patients (25 per cent) undergoing one-layer anastomosis and 28 of 50 (56 per cent) having the two-layer procedure complained of cervical dysphagia and required dilatation. The anastomotic strictures were fibrotic in 11 of 51 patients (22 per cent) undergoing one-layer anastomosis and in 24 of 50 (48 per cent) receiving the two-layer operation. Strictures were malignant in two and four patients (4 and 8 per cent) respectively. The lower incidence of fibrotic stricture following one-layer anastomosis was significant (P < 0.01), but not that of malignant stricture. With comparable leakage rates, one-layer anastomosis is superior to the two-layer procedure because of the lower incidence of fibrotic stricture.
在一项前瞻性随机研究中，对食管次全切除及胃代食管并进行颈段食管胃吻合术后的单层和双层吻合进行了比较。在54例单层吻合和53例双层吻合手术后，吻合口漏发生率相同（19%）。平均随访44周后，51例接受单层吻合的患者中有13例（25%）、50例接受双层吻合的患者中有28例（56%）主诉颈部吞咽困难并需要扩张治疗。51例接受单层吻合的患者中有11例（22%）、50例接受双层吻合手术的患者中有24例（48%）的吻合口狭窄为纤维化。分别有2例和4例患者（4%和8%）的狭窄为恶性。单层吻合后纤维化狭窄的发生率较低，差异有统计学意义（P<0.01），但恶性狭窄的发生率差异无统计学意义。在吻合口漏发生率相当的情况下，由于纤维化狭窄发生率较低，单层吻合优于双层吻合。
