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目的探讨管状胃的做法改进及其在胸中、上段食管癌切除术中的临床应用。方法回顾性分析焦作市第二人民医院自2005年8月至2010年10月期间,对126例胸中、上段食管癌患者行左侧开胸颈部吻合手术,食管次全切除,用改良的管状胃重建消化道,并重点探讨管状胃的制作方法改进。结果本组126例患者经过上述手术后,无手术死亡,无吻合口瘘,无乳糜胸发生,无胃出血,无胸胃排空障碍。发生吻合口狭窄5例,左胸腔积液4例,心律失常3例,喉返神经损伤4例。术后2周常规行钡餐透视检查,空腹透视观察无胃潴留现象,吞钡后可见胃排空良好,胸部正位片几乎看不到胸胃,术后随访1～2年,无胸胃综合征及明显反流性食管炎等并发症。结论食管癌切除术后,这种管状胃的制作简单,易于掌握,而且安全有效。解剖学上与生理食管更相似,有更长的替代长度及胃部血液循环,对胃的功能影响较小,降低了胃排空不良的发生,减少了胸胃对呼吸的影响及手术后并发症的发生,改善了患者术后生活质量。
Objective To investigate the improvement of tubular stomach and its clinical application in the resection of upper and lower esophageal cancer. Methods A retrospective analysis of Jiaozuo Second People’s Hospital from August 2005 to October 2010 period, 126 cases of upper thoracic esophageal cancer patients underwent open thoracotomy neck anastomosis, subtotal esophageal resection, with improved tubular Gastrointestinal reconstruction of the digestive tract, and focus on the improvement of the production of tubular stomach. Results The group of 126 patients after surgery, no operative death, no anastomotic leakage, no chylothorax occurred, no bleeding, no chest emptying disorder. Anastomotic stricture occurred in 5 cases, 4 cases of left pleural effusion, arrhythmia in 3 cases, 4 cases of recurrent laryngeal nerve injury. 2 weeks after conventional barium meal fluoroscopy, fasting point of observation without gastric retention, barium swallow showed good gastric emptying, chest radiographs almost can not see the chest and stomach, postoperative follow-up of 1 to 2 years, no chest and stomach synthesis Signs and significant reflux esophagitis and other complications. Conclusion After resection of esophageal cancer, the tube-shaped stomach is easy to manufacture, safe and effective. Anatomically more similar to the physiological esophagus, a longer replacement length and gastric blood circulation, less effect on the gastric function, reducing the incidence of gastric emptying, reducing the impact of the thorax and stomach and postoperative complications Occurrence of the disease, improve the quality of life of patients after surgery.