摘要
目的探讨食管胃器械吻合术后吻合口狭窄的原因和预防措施.方法 分析532例食管胃器械吻合术后出现吻合口狭窄42例的病变程度、手术技术及吻合器型号和结构的相关性.结果 42例吻合口狭窄均发生于应用外径为25～29 mm型吻合器,狭窄的吻合口内径〈6 mm占81%（34/42）,可见肉芽瘢痕填充、钛钉排列错乱,呈扭曲环缩.吻合器吻合的内径比手法吻合后内径小8.6～10.1 mm,且无扩张性.结论 排除患者体质差异及吻合技术等因素,从吻合器基本结构上建议：（1）将双环交错订书钉式吻合改成垂直式吻合;（2）将双排钛钉改为单排可吸收钉;（3）抵钉座革新为伞形可膨式;（4）消除吻合切割后内外径8.6 mm的差距.
Objective To study the etiological factors and preventive measures of anastomotic stricture after esophagogastrostomy with circular stapler. Methods The clinical data of 42 patients with anastomotic stricture among 532 cases of esophagogastrostomy with stapler in our department were reviewed. The correlation among pathological changes, type and structure was analyzed. Results All of the 42 cases of anastomotic stricture utilized stapler with external diameter of 25 mm - 29 mm. In 81% （ 34/ 42） of these cases ,the internal diameter of stoma was less than 6mm. Obstruction of granulation scar and malalignment of titanium nails were found. The internal diameter of stoma utilizing stapler was smaller than that by hand by about 8.6 mm - 10.1 mm with no dilatancy. Conclusion Besides considerations of individual difference and manipulative technique,we suggest to upgrade the structure of circular stapler as follows ： i. change double-layer interlock nail to vertical nail ; ii. change double-layer titanium staplers to single-layer absorbable stapler; iii. contrive parasol -like expansionary nail tray ; iv. obviate the gap between external and internal diameter after mechanical anastomosis.
出处
《临床外科杂志》
2012年第2期118-119,共2页
Journal of Clinical Surgery
关键词
管型吻合器
吻合口狭窄
食管胃吻合
并发症
circular stapler
anastomotic stricture
esophagogastrostomy
complications
