CAJ | 학술논문

目的:探讨贲门癌切除后行消化道重建术式的改进,预防吻合口瘘及吻合口狭窄的措施. 方法:对2000年1月-2006年12月收治的289例贲门癌患者采用食管全层与胃黏膜套叠式吻合术患者临床资料进行回顾性分析.结果:术后出现吻合口瘘3例(1.0%),肺部感染7例(2.4%).根治性切除276例,姑息性切除13例.胃切缘和食管切缘均无癌细胞残留.随访6个月-2年出现反流性食管炎12例(4.2%),吻合口狭窄2例(0.7%),吻合口处肿瘤复发1例(0.3%),死亡4例(1.4%).吻合口瘘、吻合口狭窄和反流性食管炎三大并发症发生率为5.9%(17/289).结论:贲门癌切除后行食管-胃黏膜套叠式吻合局部血运佳,解剖层次清楚,对位良好,吻合方法简单,安全,可靠,胃粘膜下层覆盖食管肌层,形成的活瓣质地柔软,结合紧密,起到人工瓣膜的作用,有效预防局部感染,具有一定的抗反流作用,有利于减少吻合口瘘和吻合口狭窄的发生,提高患者生活质量.
목적:탐토분문암절제후행소화도중건술식적개진,예방문합구루급문합구협착적조시. 방법:대2000년1월-2006년12월수치적289례분문암환자채용식관전층여위점막투첩식문합술환자림상자료진행회고성분석.결과:술후출현문합구루3례(1.0%),폐부감염7례(2.4%).근치성절제276례,고식성절제13례.위절연화식관절연균무암세포잔류.수방6개월-2년출현반류성식관염12례(4.2%),문합구협착2례(0.7%),문합구처종류복발1례(0.3%),사망4례(1.4%).문합구루、문합구협착화반류성식관염삼대병발증발생솔위5.9%(17/289).결론:분문암절제후행식관-위점막투첩식문합국부혈운가,해부층차청초,대위량호,문합방법간단,안전,가고,위점막하층복개식관기층,형성적활판질지유연,결합긴밀,기도인공판막적작용,유효예방국부감염,구유일정적항반류작용,유리우감소문합구루화문합구협착적발생,제고환자생활질량.
Objective:To approach the improvement in alimentary tract reconstruction after the operation of cardiac cancer,and measurements to prevent anastomotic leakage and anastomosis stricture. Methods:The clinical data of 289 cases with cardiac cancer treated with esophagus-gastriomucosa intussusception anastomosis from January 2000 to December 2006,were analyzed retrospectively. Results:Of the 289 cases,there were 3 cases with anastomotic leakage,7 cases with pneumonia.Among them,276 cases underwent radical operation of the tumor,13 underwent palliative surgery.No left cancer tissues was found in the ends of cardia and esophagus.There were 12 cases(4.2%) with gastroesophageal reflux,2 cases(0.7%) with anastomosis stricture,1 case(0.3%) with recurrence and 4 cases(1.4%) dead of callbacks between 6 months to 2 years.The rate of the three postoperative complications,anastomotic leakage,anastomosis stricture and gastroesophageal reflux,was 5.9%(17/289). Conclusion: It is effective to adopt the esophagus-gastriomucosa intussusception anastomosis in cardiac cancer.The blood circle is good,aratomical hierarchy distinct,jointed perfect,arastomosis method convenient,safe and reliable.The valve,which acts upon as a man-made valve,combined closely with gastriomucosa covering esophagus'muscle tissue,is soft,good at preventing infection,and superior in anti-esophagus reflux.It also reduces the happeness of anastomotic leakage and anastomosis stricture,and would improve the patients' life quality.