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目的探讨食管癌切除术预防吻合口狭窄的术式。方法回顾分析2004年12月至2009年1月我科收治的50例患者的临床资料。结果根据扩张后吻合口直径增加与自觉症状改善情况分为:完全缓解:扩张后吞咽困难症状消失,能进普食;部分缓解:扩张后吞咽困难症状改善,能进半流;无效:扩张失败,症状无改善。本组50例患者中,完全缓解45例;部分缓4例;无效1例。术后禁食4 h进温凉流食,翌日晨进半流质,午后逐步过度到正常饮食,50例中仅1例术后进食有轻微的吞咽梗阻感,随访3~36个月,经食道吞钡摄片或胃镜检查,提示无吻合口狭窄。结论吻合口狭窄一经确诊,应尽早治疗,治疗越早,效果越好,通过对本组50例改良食管胃吻合术的临床观察,其手术操作简便,对提高患者的生存质量有重要意义。
Objective To investigate the surgical methods of esophageal cancer resection for preventing anastomotic stenosis. Methods The clinical data of 50 patients admitted to our department from December 2004 to January 2009 were retrospectively analyzed. Results According to the diameter of the anastomotic after the expansion and the improvement of the symptoms are divided into: complete remission: the symptoms of dysphagia disappear after dilatation, can enter the general diet; partial remission: dysphagia symptoms after the expansion to improve, into the semi-flow; invalid: failure to expand No improvement in symptoms. In this group of 50 patients, 45 cases were completely relieved; 4 cases partially relieved; 1 case ineffective. Postoperative fasting 4 h into the cool flow of food, the next morning into the semi-liquid, gradually over the afternoon to normal diet, 50 cases of only 1 case of postoperative eating mild swallow sense of obstruction, followed up for 3 to 36 months, transmucosal swallow Barium radiography or gastroscopy, suggesting no anastomotic stenosis. Conclusion Anastomotic stenosis, once diagnosed, should be treated as soon as possible, the sooner the treatment, the better, through the clinical observation of 50 cases of modified esophageal and gastric anastomosis in this group, the operation is simple and easy to improve the quality of life of patients with great significance.