Collard J M, Romagnoli R, Goncette L, Otte J B, Kestens P J
Department of Surgery, Louvain Medical School, Brussels, Belgium.
Ann Thorac Surg. 1998 Mar;65(3):814-7. doi: 10.1016/s0003-4975(97)01384-2.
The classic manual end-to-side technique of esophagogastrostomy after gastric pull-up to the neck carries a rather high risk of fistula and stricture.
A terminalized semimechanical side-to-side technique of cervical esophagogastrostomy was performed in 16 patients by the application of an Endo-GIA stapler across the gastric and esophageal walls placed side by side, so as to create a V-shaped posterior opening between the two lumina. The anterior aspect of the anastomosis was hand-sewn using a classic running suture. The cross-sectional area of the semimechanical anastomoses was estimated by barium swallow study 2 months after operation and compared with that of 24 manual end-to-side esophagogastrostomies.
The cross-sectional area was 225 +/- 15.7 mm2 (mean +/- standard error of the mean) for the 16 semimechanical anastomoses versus 136 +/- 15 mm2 for the 24 manual anastomoses (p = 0.0001). The anastomotic area decreased from 206.6 +/- 13.5 mm2 in 29 patients without dysphagia to 107.5 +/- 4.7 mm2 in 7 patients with moderate dysphagia for solids that did not require endoscopic dilation and to 55.7 +/- 16 mm2 in 4 patients with severe dysphagia that required dilation (p = 0). The anastomotic area in 6 of the 7 patients with initial moderate dysphagia for solids increased spontaneously with time from 107.3 +/- 5.5 mm2 to 174.6 +/- 8.1 mm2, with concomitant symptomatic relief (p = 0.0277).
The terminalized semimechanical side-to-side suture technique produces a larger anastomosis than the classic end-to-side esophagogastrostomy technique. Inflammatory changes related to the operation may cause transient narrowing of a cervical esophagogastrostomy.
将胃上提至颈部后采用经典的手工端侧技术进行食管胃吻合术，发生瘘和狭窄的风险相当高。
对16例患者采用一种改良的半机械侧侧技术进行颈部食管胃吻合术，应用Endo-GIA吻合器穿过并排放置的胃壁和食管壁，从而在两个管腔之间形成一个V形后开口。吻合口的前侧采用经典的连续缝合法手工缝合。术后2个月通过吞钡研究估计半机械吻合口的横截面积，并与24例手工端侧食管胃吻合术的横截面积进行比较。
16例半机械吻合口的横截面积为225±15.7mm²（平均值±平均标准误差），而24例手工吻合口的横截面积为136±15mm²（p = 0.0001）。吻合口面积从29例无吞咽困难患者的206.6±13.5mm²降至7例固体食物中度吞咽困难且无需内镜扩张患者的107.5±4.7mm²，再降至4例严重吞咽困难且需要扩张患者的55.7±16mm²（p = 0）。7例最初固体食物中度吞咽困难患者中的6例，其吻合口面积随时间自发从107.3±5.5mm²增加至174.6±8.1mm²，同时症状缓解（p = 0.0277）。
改良的半机械侧侧缝合技术比经典的端侧食管胃吻合术产生更大的吻合口。与手术相关的炎症变化可能导致颈部食管胃吻合口短暂狭窄。
