The Clinical Effects Of Side-to-side Mechanical Anastomosis In Cervical Esophagogastrostomy Anastomosis

[BACKGROUND AND OBJECTIVE]:Esophageal cancer is one of the world’s high incidence of malignant tumors, according to statistics, the global number of deaths due to esophageal cancer, about 30 million people annually. China is one of the high incidence of esophageal cancer, the number of cases and deaths exceeded more than half of the world, the incidence was significant regional differences, specifically in the rural areas. Surgical treatment is still currently one of the main treatment of esophageal cancer. In China Professor Wu Yingkai completion of the first cases of esophageal cancer surgery has been sixty ears. Consistent with the continuous improvement of technology, clinical application of mechanical stapler, surgical treatment of esophageal cancer in recent years, have a more rapid development. In the surgical treatment of esophageal cancer, the most important aspect is the anastomosis of the esophagus and stomach after tumor resection, anastomosis is to ensure the success of the operation and postoperative complications plays an important role. Sixty years there has been a wide variety of consistent methods, such as placement esophagogastrostomy, sheath style esophageal mucosa anastomosis, within a single layer interrupted anastomosis turn, tunnel esophagogastrostomy double interrupted anastomosis and so on. Despite the agreement are many ways, but there is no way to completely solve a match three postoperative complications (anastomotic leak, anastomotic stricture, reflux esophagitis). Therefore, we conducted side-to-side mechanical anastomosis in cervical esophagogastrostomy anastomosis, and by the retrospective study, summarize the anastomotic leakage, anastomotic stenosis and the incidence of reflux esophagitis, and explore its chest clinical value of esophageal surgery.[METHODS]:Collected from January 2010 to December 2014, thoracic surgery in Shandong Cancer Hospital and Institute 175 routine thoracic esophagectomy, side-to-side mechanical anastomosis in cervical esophagogastrostomy anastomosis patients, male 95 cases, female 80 cases; aged 33 to 75 years old, with a median age of 57.6 years. Including 22 cases of thoracic on cancer,130 cases of esophageal chest, thoracic under 23 cases of cancer.175 cases of patients with varying degrees of difficulty eating dysphagia, after preoperative upper gastrointestinal barium meal examination of tumor length of about 2-9cm; lining brain, chest, abdomen strengthening CT inspection showed no distant organ metastasis; P-TNM:Ⅰ of 6 cases, IIA of 139 cases, ⅡB of 10 cases,Ⅲ of 20 cases; Retrospectively analyzed the clinical data. For postoperative anastomotic leakage, anastomotic stricture, the incidence of reflux esophagitis statistics, and consistent with the traditional surgical methods were compared.[RESULTS]:The pathologically of all the patients:154 cases of squamous cell carcinoma,1 case of squamous cell carcinoma coalition of leiomyosarcoma, 4 cases of double the original squamous cell carcinoma,1 case adenosquamous carcinoma,12 cases of esophageal squamous cell carcinoma and adenocarcinoma of the cardia. This group of patients 3 patients died, and the remaining 172 cases were cured 2 to 11 weeks after surgery. The main complications include: two cases of heart and lung failure, died after rescue; respiratory failure tracheotomy and ventilator-assisted breathing one case, death after treatment; 4 cases of anastomotic leakage, distraction neck incision and drainage, nutrient support, anti-infection treatment to cure; chylothorax four cases, after conservative treatment; chest infection three cases, the large doses of antibiotics, thoracic drainage and cure. All patients were discharged gastrointestinal barium meal examination to see on the front line of anastomotic healing well, barium through smoothly, without stenosis. Postoperative follow-up ranged from 1 to 4 years,5 cases of patients with symptoms of varying degrees of difficulty in swallowing and other gastrointestinal barium meal examination 3 patients anastomotic smaller than the inner diameter of 0.9cm, the rate was 1.74% on the line; there are 18 cases of patients with belching acid reflux, chest burning sensation symptoms, incidence of 10.28%, compared with the traditional method were significantly lower. The positive margin on cancer pathology five cases, four cases of cancer among middle upper segment carcinoma, carcinoma positive margin next three cases, both lower cancer. The middle line of the neck esophageal anastomosis anastomosis line on 130 cases and bows on the same period in positive margin rate of 7 cases of cancer were four cases (3.1%) and 3 cases (42.8%), the x2 test, comparison between the two There was a significant difference (P<0.01).[CONCLUSION]:Through this group,175 cases of patient clinical data, we analyze side-to-side mechanical anastomosis in cervical esophagogastrostomy anastomosis in the neck esophageal reconstruction, to maximize the removal of cancerous tissue, consistent with the principles of tumor cure. Cervical esophagus and stomach mechanical side to side anastomosis has a double stitched, stapled tight firm, trauma, consistent fast, reduce anastomotic tension, etc., helps to reduce the incidence of anastomotic fistula. Gastroesophageal mechanical neck side to side anastomosis can be formed about 2-3cm anastomosis, and wider than the inner diameter of the normal esophagus, and fully guarantee the anastomotic patency, with less damage, less scarring, elasticity, good benefits, and a tapered anastomotic stenosis can significantly reduce the incidence of cancer. Gastroesophageal mechanical neck side to side anastomosis can rebuild His angle to prevent acid reflux, reduce the incidence of reflux esophagitis. So side-to-side mechanical anastomosis in cervical esophagogastrostomy anastomosis can effectively prevent the anastomotic leakage, anastomotic stenosis and reflux esophagitis complications and shorten the operation time, worthy of clinical application.