摘要
我院自1987年1月～1991年12月,用外科手术治疗食管癌202例,贲门癌156例,切除326例,总切除率91%.食管癌切除率94.5%,贲门癌切除率86.6%.本文着重介绍三定点吻合法加大网膜包绕吻合口技术,应用此法未发生吻合口瘘.此法的优点:(1)三定点吻合法显露清楚,吻合准确可靠.(2)利用定点吻合牵引线使食管胃的全层创缘自然合拢一条线上保证粘膜平整.(3)使吻合口建立在有良好血供的健康组织上才有利于愈合.通过术后部分病例的纤维食管镜检查发现食管胃吻合的粘膜平整,生长好,对合满意,术后发生各种并发症24例,发生率7.5%(24/326),其中吻合口狭窄8例,肺炎6例,单纯性包裹性脓胸4例,切口感染3例,左侧乳糜胸2例,急性心梗1例,死亡.其余23例经治疗后痊愈出院.
The results of surgical treatment in 202 cases of esophageal carcinoma and 156 cases of carcinoma of gastric cardis from January 1987 to december, 1991 were evaluated, 326 cases in the series underwent resection. Was 94.5% for carcinoma of esophagus and 86. 6% for carcinoma of gastric cardia was 91% the totalresectable rate.The paper emphasizes the technic attraction fixation at three points and the use of greater omentum in protecting the site of anastomosis. The advantages of this method are as following, (1) Traction fixation by threestiches at the site of anastomosis gives better exposure and makes the suture to the point and reliable, (2)Approximation of the whole layer of esophagus and stomach become easy and smooth, (3) Good blood supply tothe site of anasromosis. Postoperative follow up with fiberoptic esophegoscopy 24 cases showed satisfact or healing with good approximation and smooth mucous membrane. The incidence of postoperative complication was 7.5% including S cases of stricture, 6 cases of pneumonia,4 cases of encapsulated empyema, 4 of wound infectiones. 2 of chylo thorax, and one acute mycoardiac infarction. The operative mortality was 0.3%.
