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目的探讨横行“8”字浆膜-黏膜下层缝合在食管空肠吻合中的应用效果。方法 43例行根治性全胃切除术的食管胃结合部腺癌患者,术中吻合不满意需行吻合口加固,其中25例采用横行“8”字浆膜-黏膜下层缝合(观察组),余18例采用常规方法加针缝合(对照组),分析2组手术操作时间、吻合口缝合针数、术中及术后并发症发生情况。结果观察组(4.3±2.2)针可完成吻合口全周加固,缝合时间(10.5±4.5)min;对照组需(7.6±4.4)针完成吻合口全周加固,缝合时间为(21.4±6.8)min,2组比较差异有统计学差异(P<0.05);观察组无严重食管全层撕裂或食管外膜层撕裂、吻合口瘘及吻合口出血发生;对照组加针过程中1例出现严重撕裂,后行切断后重新吻合,3例出现肉眼外膜撕裂,术后发生吻合口瘘3例、吻合口出血3例,2组比较差异有统计学意义(P<0.05);观察组术后1周吻合口直径为(24.5±7.8)mm,对照组为(16.4±6.5)mm(P<0.05)。结论食管空肠吻合不满意时采用横行“8”字浆膜-黏膜下层缝合疗效确切。
Objective To investigate the effect of transverse “8 ” serosal-submucosal suturing in esophageal jejunostomy. Methods Forty - three patients underwent radical gastrectomy for esophagogastric junctional adenocarcinoma were enrolled in this study. The anastomosis was not satisfactory during the operation. Forty - five cases were treated with transverse suture and submucosal suturing (observation group ), And the remaining 18 cases were treated with conventional suture and needle suture (control group). The operation time, anastomotic stitch number, intraoperative and postoperative complication were analyzed. Results The needle of the observation group (4.3 ± 2.2) was able to complete the anastomotic stabilization and the suture time was (10.5 ± 4.5) min. The control group needed (7.6 ± 4.4) needle to complete the anastomotic stabilization and the suture time was (21.4 ± 6.8) min, the difference between the two groups was statistically significant (P <0.05); the observation group without serious esophageal full tear or esophageal outer tear, anastomotic leakage and anastomotic bleeding occurred in the control group during needle injection Severe torn laceration occurred, and after the resection, the anastomosis was reformed. There were 3 cases of external tear of the macroscopic anastomotic fistula, 3 cases of anastomotic fistula and 3 cases of anastomotic bleeding after operation. There was significant difference between the two groups (P <0.05). The diameter of the anastomosis in the observation group was (24.5 ± 7.8) mm at 1 week after operation and (16.4 ± 6.5) mm in the control group (P <0.05). Conclusion esophagojejunostomy is not satisfied with the use of transverse “8 ” serosa - submucosal suture is effective.