食管癌手术中食管胃吻合技术的选择及疗效评价

Choice and efficacy evaluation of esophagogastric anastomosis in esophagectomy of esophageal cancer

  • 摘要: 食管癌切除术均需行消化道重建,食管胃吻合术是关键技术,其很大程度上决定患者短期预后。成功的食管胃吻合术至少应做到术后早期无吻合口出血与吻合口瘘发生,并在后期无吻合口狭窄。常用吻合方式有圆形吻合器、直线型切割缝合器及手工吻合。手工吻合是最传统、最经典的吻合方式。使用圆形吻合器吻合简便、省时、可靠,已成为食管胃吻合术主流方式。直线型切割缝合器食管胃侧侧吻合可扩大吻合口内径,减少吻合口狭窄。各种吻合方式均有其优、缺点,且不能完全避免吻合口并发症,外科医师应根据自身经验及患者具体情况个体化选择吻合方式,使患者获得最佳治疗效果。

     

    Abstract: Esophageal reconstruction is of greatimportance in the practice of esophagectomy, and esophago-gastric anastomosis represents the most essential and key technical aspect of the operation, which largely determined patients′short-term outcomes. A successful esophageal anastomosis should be no occurrences of postoperative early-stage anastomotic bleeding and leakage and later-stage anastomotic stenosis. The circular stapler, linear cut stapler and hand-sewn anastomosis are the most common anastomotic methods. Hand-sewn anastomosis is the most traditional and classical. Circular stapler has gainedsignificant popularity for its simplicity and convenience. Linear cut stapler used for side-to-side anastomosis has the potential to reduce the risk of postoperative anastomotic stenosis via expanding inner diameter of anastomosis. Every anastomotic method has its advantages and disadvantages, and it cannot completely avoid occurrence of postoperative anastomotic complications. To have a better outcome, both surgeon′s experiences and patient′s individual conditions should be taken into consideration for the choice of anastomotic technique.

     

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