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目的:探讨食管癌切除、颈部食管胃侧侧吻合术的治疗效果及应用前景。方法:18例中上段食管癌患者行食管癌切除、颈部食管胃侧侧吻合术,并对其临床资料进行回顾性分析。术中按肿瘤手术切除原则常规游离食管及近端胃,切除肿瘤,将胃缝缩成管型;取颈部切口,暴露并游离颈段食管;根据手术切口的不同,采取不同径路将管型胃经食管床上提至颈部,将管型胃与颈段食管重叠约5cm,在胃前壁距胃底约5cm处戳一小口,将食管断端切成前长后短的斜行,将切割缝合器的钉槽插入胃内、钉仓插入食管腔,击发缝合并切割,将食管斜行断端与管型胃前壁缝合,形成长约3cm的吻合口;管型胃顶端固定于吻合口上方的颈椎前筋膜,完成颈部食管胃侧侧吻合。结果:本组病例术后分期分别为Ⅱa期(4例)、Ⅱb期(9例)、Ⅲ期(5例)。手术径路分别为不开胸颈腹两切口(8例)、右胸颈腹三切口(9例)、左胸颈两切口(1例)。全部病例均手术顺利,术后出现吻合口瘘1例,发生率为5.56%,颈部引流、禁食2周后治愈;全部病例出院前复查上消化道钡透均见吻合口通畅、无狭窄,术后随诊1～5年不等,均未见吻合口狭窄,但有2例患者出现返流性食管炎症状,发生率为11.11%。结论:颈部食管胃侧侧吻合术可有效预防术后吻合口并发症的发生,值得临床推广。
Objective: To investigate the therapeutic effect and application prospect of esophagectomy and cervical esophagogastric anastomosis. Methods: Eighteen patients with upper esophageal cancer underwent esophageal resection and cervical esophagogastric side anastomosis, and their clinical data were retrospectively analyzed. Surgery according to the principle of surgical resection of the tumor conventional free esophageal and proximal stomach, resection of the tumor, the stomach suture into the tube; take the neck incision, exposed and free cervical esophagus; according to the different surgical incision, Stomach esophageal bed raised to the neck, the tube-shaped stomach and cervical esophagus overlap about 5cm, gastric anterior wall at a distance of about 5cm poke a small mouth, the esophagus stump cut into long before and after the short oblique, the Cutting stapler staple slot into the stomach, the staple cartridge into the esophageal cavity, firing and cutting, the esophageal oblique ends of the anterior gastric tube suture to form anastomosis about 3cm; tube-shaped stomach top is fixed to Anterior cervical fascia above the anastomosis to complete the cervical esophagogastric anastomosis. Results: The postoperative staging of this group were Ⅱa (4 cases), Ⅱb (9 cases) and Ⅲ (5 cases). Surgical approach were not incision of the thoracotomy abdominal incision (8 cases), right thoracotomy abdominal incision (9 cases), left chest and neck incision (1 case). All the cases were operated successfully. One case of anastomotic fistula occurred after operation, the incidence rate was 5.56%. The neck was drained and cured after 2 weeks of fasting. All cases were examined before discharge and barium penetration of upper digestive tract showed anastomotic patency and no stenosis , Followed up for 1-5 years, no anastomotic stenosis, but 2 cases of reflux esophagitis symptoms, the incidence was 11.11%. Conclusion: The cervical esophagogastric anastomosis can effectively prevent the occurrence of postoperative anastomotic complications and is worthy of clinical promotion.