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目的探讨经胃黏膜下层食管胃黏膜单层吻合的抗返流作用。方法 412例食管下段癌、贲门癌患者,按肿瘤根治要求切除,残胃残端予以闭合器关闭,胃体部大弯侧作黏膜下隧道,长3.0 cm,宽3.0 cm;游离食管末端黏膜层,食管黏膜穿入胃壁隧道内与胃黏膜层吻合,食管肌层与隧道入口处胃壁浆肌层间断缝合,隧道出口胃壁浆肌层切口间断缝合关闭隧道。结果无吻合口瘘、吻合口狭窄发生,2例有少量反酸,其中68例患者行纤维胃镜检查:吻合口上3～4 cm处食管呈关闭状态,黏膜无充血水肿及糜烂,血管纹理清晰。食管黏膜活检按Menin氏标准分级:0、Ⅰ、Ⅱ级分别有10例(14.7%)、47例(69.1%)和11例(16.2%),无Ⅲ级病例。食管液pH值测定,pH值为6.5、7.0、7.5分别有13例(19.1%)、46例(67.7%)和9例(13.2%)。结论经胃黏膜下层食管胃黏膜单层吻合适于病变小的食管癌、贲门癌患者,具有良好地抗返流作用。
Objective To investigate the anti-reflux effect of single-layer anastomosis of gastric and gastric mucosa through the gastric mucosa. Methods 412 patients with esophageal cancer and cardia cancer underwent radical resection. The residual gastric stump was closed with a closure device. The large curved side of the gastric body was used as a submucosal tunnel with 3.0 cm in length and 3.0 cm in width. The esophageal mucosa penetrated into the gastric tunnel and anastomosed with the gastric mucosa. The esophageal muscle layer was interrupted by suture of the muscular layer of the gastric wall at the entrance to the tunnel. Results There were no anastomotic fistulas and anastomotic stenosis. A small amount of acid reflux occurred in 2 patients. Among them, 68 patients underwent endoscopy. The esophagus was closed at 3 ~ 4 cm at the anastomotic site. The mucosa had no congestion, edema and erosions. The vascular texture was clear. Esophageal mucosa biopsy was classified according to Menin’s criteria: 10 cases (14.7%), 47 cases (69.1%) and 11 cases (16.2% Esophageal fluid pH values were found in 13 cases (19.1%), 46 cases (67.7%) and 9 cases (13.2%) with pH values of 6.5, 7.0 and 7.5 respectively. Conclusion Stomach mucosa anastomosis through the lower gastric mucosa suitable for patients with esophageal cancer, cardia cancer patients with small lesions, has a good anti-reflux effect.