胃腔内食管胃吻合术７４例体会晋中地区第一人民医院（０３０６００）赵仁昌，张聪，周毅民，魏喜贵，程书栋，王波，王建文食管贲门癌切除术后食管胃吻合很难避免吻合口瘘和吻合口狭窄的发生。为此１９８８年４月至１９９１年７月间，我们采用邵令方［１］介绍的“胃腔内食管胃吻合法”共７４例，收到良好的效果，现介绍如下。资料与方法本组７４例中，年龄３７～７１岁，平均５６岁；男性５１例，女性２３例；其中食管癌３１例；贲门癌４３例；行食管胃主动脉弓上吻合２７例，主动脉弓下吻合４７例。手术方法：①７４例均经左侧进胸，常规切除肿瘤食管后，距食管近侧断端３ｃｍ处完成吻合口后壁之食管一胃浆肌层三针间断缝合。按食管口径之大小切开胃壁，准备行胃腔内食管胃吻合术（见图１）。②在吻合口周围作前、后、左、右相对称的四针食管胃全层缝合，除吻合口前壁的一针缝线暂不打结外，其余均打结作为牵引线（见图２）。③经贲门切口或胃小弯侧切口将上述四针牵引线用血管钳拉入胃内，吻合口即随之进入胃腔，部分拉至贲门切口之外（见图３）。④分别向四个不同的方向牵拉牵引线，并结扎吻合口前壁之一针缝线，使吻合口张开呈四方形（见图４）。⑤在四条牵引线之间行食管胃全层间断吻合，间距约 Gastrointestinal esophagogastric anastomosis in 74 cases Experience in the First People’s Hospital of Jinzhong District ZHAO Ren-chang, ZHANG Cong, ZHOU Yi-min, WEI Xi-gui, CHENG Shu-dong, WANG Bo, WANG Jian-wen Esophagogastrostomy after resection of esophageal and cardiac cancer is difficult to avoid anastomotic leakage Anastomotic stricture occurs. For this reason, from April 1988 to July 1991, we used the “intragastric esophagogastric anastomosis method” introduced by Shao Lingfang [1] in a total of 74 cases, and received good results, which are described below. Data and Methods 74 patients in this group aged 37 to 71 years old, average 56 years; 51 males and 23 females; 31 cases of esophageal cancer; cardiac cancer in 43 cases; line of esophagogastric aortic arch anastomosis in 27 cases, aortic arch anastomosis 47 cases. Surgical methods: 174 cases were received by the left side of the chest, after the removal of the conventional esophageal cancer, 3cm from the proximal end of the esophagus at the completion of anastomotic posterior wall of the esophagus and a three-needle interrupted suture of the stomach muscle. According to the size of the esophageal caliber cut the appetite wall, ready for gastric esophageal gastric anastomosis (see Figure 1). 2 The four-needle esophagogastric full-stitched suture around the anastomotic stoma is made up of the anterior, posterior, left, and right counterparts. Except for the suture of the anastomotic stoma, the sutures are not knotted, and the others are knotted as a pulling line (see figure). 2). 3 The cardiopulmonary forceps are pulled into the stomach through a cardia incision or a small incision in the stomach. The anastomosis port then enters into the stomach cavity and is partially pulled out of the cardiac incision (see Figure 3). 4 Pull the pull wire in four different directions and ligate one of the needle sutures on the anterior wall of the anastomotic stoma, so that the anastomosis opening is square (see Figure 4). 5 In the esophagogastric full-line intermittent anastomosis between the four traction lines, spacing