Csíkos M, Baradnay G
Surgical Department, Municipial Hospital, Szeged, Hungary.
Acta Chir Hung. 1997;36(1-4):57-8.
Among the surgical techniques used to create a reliable oesophageal anastomosis, mention should be made of the handmade (in one or two layers, wire or Vicryl) and the different stapler anastomoses. 41 oesophageal anastomoses were performed by stapler technique between 4 March 1985 and 4 March 1991. The EEA stapler was used in 15, and the SPTU stapler in 26 patients. The average age was 56.8 years overall, 53.6 in the female (7 patients) and 57.4 years in the 34 male patients. Tumours in the middle and lower third of the oesophagus and on the cardia were the indications for resection in 30 instances. Total gastrectomy was performed in 9 patients and oesophageal resection for peptic stricture in 2 cases. Replacement with stomach was carried out after oesophageal resection (17 patients), and with Roux-loop in 24 cases. The EEA anastomoses were not covered by a hand-made layer of interrupted sutures as is compulsory in the case of the SPTU gun. The intraoperative complication rate was 12.2%--two severe complications with the SPTU and 3 mild ones with the EEA (2 cases) and SPTU (1 case) machines. The postoperative complication rate was 17%--the severe ones with the SPTU gun. The only fatal anastomosis insufficiency was observed in this group. 3 of the 41 patients died--a mortality rate of 7.3%--but only one of them was due to technical failure in the SPTU group: 2.4%.
Both the intra- and postoperative complications were more severe with the SPTU technique. The early postoperative complications are closely related to the intraoperative ones. Mortality due to technical failure was only observed in the SPTU group. The EEA stapler gun is superior in every respect to the SPTU sewing-machine. The future belongs to the even more sophisticated bent and modifiable devices. These were used in our Department Between 1992 and 1997, with practically no morbidity and no mortality. Although they are the most expensive of all the possibilities, the low morbidity and mortality rates pay off from the aspects of the short hospital stay and the savings in human life.
在用于建立可靠食管吻合的外科技术中，应提及手工缝合（一层或两层，丝线或薇乔线）以及不同的吻合器吻合。1985年3月4日至1991年3月4日期间，采用吻合器技术进行了41例食管吻合。15例使用EEA吻合器，26例使用SPTU吻合器。总体平均年龄为56.8岁，女性（7例）为53.6岁，34例男性患者为57.4岁。食管中下段及贲门部肿瘤30例为切除指征。9例患者行全胃切除术，2例因消化性狭窄行食管切除术。食管切除术后用胃替代（17例），24例用Roux袢替代。EEA吻合不像SPTU吻合器那样必须用手工间断缝合覆盖。术中并发症发生率为12.2%——SPTU吻合器出现2例严重并发症，EEA吻合器（2例）和SPTU吻合器（1例）出现3例轻微并发症。术后并发症发生率为17%——SPTU吻合器出现严重并发症。该组仅观察到1例致命的吻合口漏。41例患者中有3例死亡——死亡率为7.3%——但其中只有1例是由于SPTU组的技术失误：2.4%。
SPTU技术的术中和术后并发症都更严重。术后早期并发症与术中并发症密切相关。仅在SPTU组观察到技术失误导致的死亡。EEA吻合器在各方面都优于SPTU缝合器。未来属于更精密的可弯曲和可改装器械。1992年至1997年我们科室使用了这些器械，几乎没有发病率和死亡率。尽管它们是所有选择中最昂贵的，但低发病率和死亡率从缩短住院时间和挽救生命的角度来看是值得的。
