管状胃延长术是食管癌切除术后胃食管高位吻合时的应急选择

摘要

Objective To summarize our experience with tubular gastric elongation surgery for management of insufficient gastric length for high esophageal-gastric anastomosis following esophageal carcinoma resection. Methods From September, 2015 to October 2016, 5 patients with esophageal cancer were treated in our department, including two with cervical esophageal cancer and 3 with thoracic esophageal cancer. The patients with cervical esophageal cancer underwent pharyngeal resection, total laryngectomy, esophageal varus extubation and gastric oropharyngeal anastomosis, and the patients with thoracic esophageal cancer underwent esophageal cancer resection with incisions on the left neck, the right chest and the median abdomen. During the surgery, the length of the stomach was found insufficient to allow routine oropharyngeal anastomosis, and tubular gastric elongation was conducted to extend the tubular stomach to enable successful completion of the surgery. Results All the patients recovered smoothly after the surgery and were discharged after 2-3 weeks. Conclusion Tubular gastric elongation surgery can be a good choice for high esophageal-gastric anastomosis after resection of esophageal cancer in cases of insufficient tubular stomach length or high tension at the anastomosis.%目的 介绍管状胃延长术这一创新的手术方法 ,并报道应用该手术方式实行食管癌切除及食管-管状胃颈部吻合的成功案例.方法 报道我科自2015年9月～2016年10月收治的5名食管癌患者,2例诊断为颈段食管癌,3例胸中段食管癌,颈段食管癌患者行下咽切除+全喉切除+食管内翻拔脱+胃口咽吻合术,胸中段食管癌患者行左颈、右胸、腹正中三切口食管癌切除+食管-胃颈部吻合术,术中发现患者胃长度不够,难以在口咽部进行吻合,故被迫进行管状胃延长术以尽量延长管状胃.结果 全部患者手术成功,术后恢复情况良好,术后7～12 d行上消化道造影未发现明显异常,术后2～3周病情平稳出院.结论 食管癌切除食管-胃高位吻合时,若发现管状胃长度不够或吻合口张力较高,管状胃延长术也许是个不错的应急选择.