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目的:探讨Ivor-lewis术中胸腔内全机械性食管胃侧侧吻合应用的安全性及效果。方法:自2009年1月至2011年2月在Ivor-lewis食管癌根治术中应用直线型切割缝合器纵向缝合食管胃吻合口后壁,使吻合口后壁延长至3cm以上,同时应用直线型切割缝合器闭合吻合口前壁,完成食管胃侧侧吻合18例。术后随访观察进食情况,纤维胃镜、造影评估吻合口内径。结果:17例顺利完成胸腔内全机械性食管胃侧侧吻合;术后均无吻合口瘘,切缘无癌残留。术后随访3～24个月,进食通畅,行胃镜检查7例,造影检查15例,1例患者吻合口轻度狭窄,无因吻合口狭窄行内镜扩张,吻合口面积为(2.23±0.35)cm~2。结论:Ivor-lewis术中胸腔内全机械性食管胃侧侧吻合应用安全可靠,能够有效改善患者术后吻合口狭窄发生,从而减少因吻合口狭窄行内镜扩张次数,但由于缺乏科学的随机对照研究,因此尚不能明确其是否可以替代传统管型吻合器吻合。
Objective: To investigate the safety and efficacy of intra-thoracic mechanical all-side esophagogastric anastomosis in Ivor-Lewis surgery. Methods: From January 2009 to February 2011, the posterior wall of esophagogastric anastomosis was longitudinally sutured with a linear incision suture in Ivor-lewis radical resection of esophageal carcinoma, and the anterior posterior wall of the anastomosis was extended to more than 3 cm. At the same time, Cutting suture anastomosis anterior closed wall to complete the esophagogastric anastomosis in 18 cases. Postoperative follow-up observation of eating, fiber endoscopy, angiography to assess the anastomotic diameter. Results: Seventeen patients underwent complete mechanical esophagogastric side anastomosis successfully. No anastomotic fistula was found after operation, and there was no residual cancer at the margin. The patients were followed up for 3 to 24 months and had adequate feeding. Seven patients underwent gastroscopy and 15 underwent angiography. One patient had anastomotic stenosis with no endoscopic dilation due to anastomotic stenosis. The anastomotic area was (2.23 ± 0.35) ) cm ~ 2. Conclusions: Intra-thoracic esophageal and stomach anastomosis in Ivor-Lewis surgery is safe and reliable, which can effectively reduce the occurrence of anastomotic stenosis and reduce the number of endoscopic dilation due to anastomotic stenosis. However, due to lack of scientific randomization Control study, it is not clear whether it can replace the traditional tubular stapler anastomosis.