ASO：河南省人民医院副主任医师务森发现通过环型吻合进行嵌入式颈部食管胃吻合结局较好

手术图解

食管切除术后最常用的食管重建方法即为颈部食管胃吻合术。对于手工缝合、线型吻合或环型吻合等吻合方式的优缺点，近年来存在争议。对此，我国河南省人民医院副主任医师务森等人建立了一种端侧吻合新方法，通过环型吻合将吻合部位及残余食管组织嵌入至胃腔部，该方法可减少吻合口瘘发生率并可减少胃食管返流现象发生。该研究结果发表于2013年5月5日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上。
研究人员针对127例接受食管切除术治疗后的食管癌患者，在击发吻合器并将残存食管嵌入吻合至胃部之前，在胃内部将环型吻合器砧部及体部进行连接，通过食管嵌入方法完成端侧吻合。该研究还对如渗漏、狭窄及胃食管返流等术后并发症情况进行了回顾性考察。
最终共123例(96.9 %)患者成功完成手术，其中4例(3.3 %)患者出现吻合口渗漏，在123例患者中，共有20例患者发病(16.3 %)，1例(0.8 %)患者出现院内死亡。在123例患者中，有14例(11.4 %)患者出现狭窄(<1 cm)。有8例(6.5 %)患者因严重吞咽障碍而接受扩张治疗。半数[123例患者中有62 例 (50.4 %)]患者出现术后胃灼热，11例(8.9 %)患者出现胃酸反流，16例(13.0 %)患者出现夜咳症状。
研究人员认为，通过环型吻合进行的嵌入式颈部食管胃吻合为一种简便的手术方式，该方法具有吻合口瘘发生率低的特点，并具有较佳的抗返流效应。

Embedded Cervical Esophagogastrostomy: A Simple and Convenient Method Using a Circular Stapler After Esophagectomy for Esophageal Carcinomas.
BACKGROUND
Cervical esophagogastrostomy is currently the most common method for esophageal reconstruction after esophagectomy. The advantages and disadvantages of hand-sewn, linear-stapled, or circular-stapled anastomoses have been subject to debate in recent years. We explored a new method of end-to-side anastomosis using a circular stapler that embeds the anastomosis and the remaining esophageal tissue into the gastric cavity to reduce the occurrence of anastomotic leakage and to prevent gastroesophageal reflux.
METHODS
In 127 patients with esophageal carcinomas, end-to-side anastomoses with esophageal embedding were performed by connecting the anvil and body of the circular stapler inside the stomach before firing and embedding the anastomosis and remaining esophagus into the stomach after esophagectomy. Retrospective investigations on postoperative complications such as leakage, stricture, and gastroesophageal reflux were conducted.
RESULTS
A total of 123 patients (96.9 %) had successful surgery, and 4 patients (3.3 %) developed anastomotic leakage, with the total morbidity of 20 of 123 (16.3 %) and in-hospital mortality of 1 of 123 (0.8 %). The incidence of stricture (<1 cm) affected 14 of 123 patients (11.4 %). Eight patients underwent dilatation treatment as a result of severe dysphagia (6.5 %). Half of the patients [62 of 123 (50.4 %)] experienced postoperative heartburn, 11 of 123 patients (8.9 %) experienced acid regurgitation, and 16 of 123 patients (13.0 %) experienced nocturnal cough.
CONCLUSIONS
Embedded cervical esophagogastrostomy with circular stapler is a simple and convenient method, with low incidence of anastomotic leakage and a good antireflux effect.