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目的探讨管状吻合器在胸段食管癌切除胃代食管颈部吻合术中的技术方法,总结其应用经验。方法回顾性总结228例胸段食管癌患者的临床资料,其中77例行胸段食管癌切除食管胃颈部管状吻合器吻合术,151例行手工吻合术。结果术后吻合口瘘、乳糜胸、喉返神经损伤、胸胃排空障碍发生率两组无明显差异(P>0.05),但管状吻合器组手术吻合时间显著缩短(P<0.05),吻合口狭窄发生率明显降低(P<0.05)。结论管状吻合器适用于多数胸段食管癌切除胃代食管颈部吻合术,吻合时间短,创伤小,术后并发症发生率低;但对于颈段食管直径过细、胃长度不足等情况更宜手工吻合。术中切除胃小弯制作管状胃可有效延长胃长度,对成功进行胸段食管癌切除胃代食管颈部管状吻合器吻合有帮助。
Objective To investigate the technique of tubular stapler in resecting gastric esophageal and cervical anastomosis in thoracic esophageal cancer and summarize its application experience. Methods The clinical data of 228 patients with thoracic esophageal cancer were retrospectively reviewed. Totally 77 patients underwent thoracic esophagectomy for esophagogastrostomy and 151 for manual anastomosis. Results The incidence of anastomotic fistula, chylothorax, recurrent laryngeal nerve and thoracic gastric emptying had no significant difference between the two groups (P> 0.05), but the operation time of tubular anastomosis group was significantly shorter (P <0.05) The incidence of stenosis was significantly lower (P <0.05). Conclusions Tubular stapler is suitable for the resection of gastric esophageal neck anastomosis in most thoracic esophageal cancers with short anastomosis time and small trauma and low incidence of postoperative complications. However, it is more appropriate for the cervical esophageal diameter to be too small and the gastric length to be insufficient Manual match. Intraoperative resection of the gastric lesser curvature of the tubular stomach can effectively extend the length of the stomach, the success of thoracic esophageal resection of the stomach on behalf of the esophageal neck stapling anastomosis helpful.