目的：探讨食道癌贲门癌术后两种重建方法的优劣。方法：实验组食管癌贲门癌切除术后采用圆形吻合器行食管胃器械吻合，吻合口4号丝线间断加强并另行吻合口大网膜缠绕并吻合合口减张。对照组行食管胃粘膜及粘膜下分层吻合加胃浆肌层与食管肌层缝合包埋吻合口并减张重建。比较两组手术时间，术后肺部感染和肺不张、吻合口瘘和狭窄及胃食管反流发生率。结果：实验组吻合口瘘发生率为0.6%（2/316），吻合口狭窄发生率为5.7%（18/316），对照组吻合口瘘发生率为1.6%（3/186），吻合口狭窄发生率为4.3%（8/186），均有显著性差异（P＜0.05）。吻合口近端胃食管反流液随机抽样检查pH值，差异无统计学意义（P＞0.05）。行机械吻合手术时间明显缩短，有统计学意义（P＜0.05）。实验组肺部感染发生率0.3%（1/316），无肺不张，对照组肺部感染发生率1.6%（3/186），肺不张0.5%（1/186），其差异有统计学意义（P＜0.05）。结论：食管癌贲门癌切除术中行机械吻合重建方便快捷，可减少并发症，适于临床临床推广。
【摘要】目的比较胃肠机械吻合与传统手工吻合对术后并发症的影响，探讨机械吻合的安全性问题。 方法对我院1999年1月至2003年12月期间收治的932例行Billroth Ⅱ式胃肠吻合术患者的资料进行回顾性分析，了解其术后并发症的发生情况。 结果行机械吻合的392例中出现术后并发症8例（吻合口漏7例，梗阻1例），其发生率为2.04%； 而使用传统手工吻合的540例中出现术后并发症44例（吻合口漏28例，出血4例，梗阻12例），其发生率为8.15%，明显高于前者（P＜0.01）。 结论胃肠机械吻合较传统手工吻合更为安全。
Objective To assess the effectiveness and safety of hand-suture vs. stapling anastomosis in esophagogastrostomy. Methods The following databases such as CBM (1978 to February 2012), VIP (1989 to February 2012), CNKI (1994 to February 2012), WanFang Data (1980 to February 2012), The Cochrane Library, PubMed (1966 to February 2012), EMbase (1974 to February 2012), and relevant webs of clinical trials were searched to collect the randomized controlled trials (RCTs) and quasi-RCTs about hand-suture vs. stapling anastomosis in the incidence of anastomotic leakage following esophagogastrostomy. Moreover, relevant references and grey literature were retrieved on web engines including Google Scholar and Medical Martix, and the Chinese periodicals e.g. Chinese Journal of Oncology were also handsearched. According to the inclusion and exclusion criteria, the literature, was screened, the data were extracted, and the quality of the included studies was assessed. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 9 RCTs involving 2 202 patients were included. The result of meta-analysis was as follows: the incidence of anastomotic leakage in the stapling anastomosis group was lower than that in the hand-suture anastomosis group (OR=0.43, 95%CI 0.26 to 0.71, Plt;0.01). Conclusion Stapling anastomosis is superior to hand-suture anastomosis in reducing the incidence of anastomotic leakage following esophagogastrostomy. For the limited quality and quantity of the included studies, this conclusion has to be further proved by more high-quality studies.
ObjectiveTo compare the antireflux effects of lip reinforcement, His angle reconstruction with fundoplication, and mechanical anastomosis only in mechanical anastomosis for esophageal and cardiac carcinoma. MethodsOne hundred and seventysix patients with esophageal or cardiac carcinoma admitted to this hospital between March 2008 and October 2009 were included, which were divided into mechanical anastomosis group (n=42), His angle reconstruction group(n=56), and lip reinforcement group (n=78) according to the sequence of admission. Mechanical anastomosis only, mechanical anastomosis His angle reconstruction with fundoplication, and mechanical anastomosis liptype reinforcement were performed in the corresponding group, respectively. Endoscopy and biopsy were conducted to evaluate the antireflux effects on 3 months after operation. ResultsThere were no differences on the gender, age, tumor location, anastomosis site, and incision among three groups (Pgt;0.05). The reflux rates of the mechanical anastomosis group, His angle reconstruction group, and lip reinforcement group were 69.05%, 28.57%, and 14.10%, respectively. The reflux rates in the lip reinforcement group and His angle reconstruction group were significantly lower than those in the mechanical anastomosis group (χ2=37.088, P=0.000; χ2=15.833, P=0.000), moreover, the rate in the lip reinforcement group was significantly lower than that in the His angle reconstruction group (χ2=4.241, P=0.039). There was no anastomotic leakage in the lip reinforcement group and all patients safely discharged from hospital after surgery, only 2 patients had moderately anastomotic stenosis and both of them had good recovery with endoscopic dilatationl. The reflux after operation was independent of anastomosis sites (Pgt;0.05). ConclusionBoth liptype reinforcement and His angle reconstruction can improve the ability of antireflux, liptype reinforcement is better and simple to mainpulate.
ObjectiveTo explore clinical outcomes of complete mechanical cervical side-to-side esophago-gastric tube anastomosis. MethodsClinical data of 60 patients with esophageal carcinoma (EC)who underwent complete mechanical cervical side-to-side esophago-gastric tube anastomosis in the 153rd Central Hospital of People's Liberation Army from June 2010 to June 2012 were retrospectively analyzed. There were 41 male and 19 female patients with their age of 46-78 (64.2±6.4)years and body weight of 58.6±12.6 kg. There were 39 patients with mid-thoracic EC, 15 patients with lower-thoracic EC, and 6 patients with upper-thoracic EC. There was 1 patient with stageⅠ EC, 32 patients with stage Ⅱ EC, 23 patients with stage Ⅲ EC, and 4 patients with stage Ⅳ EC. Six to 12 months after the operation, all the patients received a survey questionnaire regarding their quantity and quality of food intake as well as gastroesophageal reflux (GER). Fifty-two patients received barium swallow, and 38 patients received gastroscopy and esophageal mucosal biopsy during follow-up. ResultsAll the 60 patients were successfully discharged. Average length of hospital stay was 12.0±2.6 days. Average time for anastomosis was 18.4±3.2 minutes. The incidence of anastomotic leak was 1.7% (1/60). During follow-up, all the 60 patients restored normal food intake, and 14 patients (23.3%)had GER symptoms. Barium swallow showed the average anastomotic diameter of 1.6±0.2 cm (range, 1.2 to 2.2 cm). In 45° trendelenburg position, 31 patients (59.6%)had barium GER, but none of the patients had prolonged barium retention, intrathoracic gastric dilation or disturbed gastric emptying. Gastroscopy of 38 patients showed full anastomotic opening in 24 patients (63.2%)and irregular or semiclosed anastomosis in the other 14 patients (36.8%). Mucosal biopsy under gastroscopy showed chronic inflammation in 18.4% (7/38)patients. ConclusionComplete mechanical cervical side-to-side esophago-gastric tube anastomosis can significantly prevent anastomotic stenosis, leak and intrathoracic stomach symptoms with good clinical outcomes.
ObjectiveTo investigate the influence of semi-mechanical and hand-sewn esophagogastric anastomoses on postoperative anastomostic complications in patients undergoing esophagectomy. MethodsA systematic, computer-aided literature search was performed in PubMed, OVID, CNKI and BioMed databases for studies which were published from database establishment to December 2013. A manual literature search was also performed. We included randomized controlled trials (RCT)and observational studies which investigated the influence of semi-mechanical and conventional hand-sewn esophagogastric anastomoses on postoperative anastomostic complications. Quality assessment and data extraction were performed, and RevMan 5.2 was used for meta-analysis. ResultsTwelve relevant studies with 1 271 patients were included (3 RCTs and 9 observational studies).No significant heterogeneity among the 12 trials was found, so fixed effects model was used for meta-analysis.There was statistical difference in the incidence of postoperative anastomotic leak between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.34, 95%CI (0.12, 0.97), P < 0.05;observational studies OR=0.40, 95%CI (0.26, 0.62), P < 0.05]. Postoperative incidence of anastomostic stricture was reported in all 12 studies. There was statistical difference in the incidence of postoperative anastomotic stricture between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.14, 95%CI (0.04, 0.47), P < 0.05;observational studies OR=0.22, 95%CI (0.15, 0.34), P < 0.000 1]. ConclusionsCompared with conventional hand-sewn anastomosis, semi-mechanical esophagogastric anastomosis can significantly reduce the incidence of postoperative anastomostic leak and stricture. Due to limited quantity and quality of included studies, more high-quality studies with larger sample size including RCT and non-randomized studies are needed to confirm these findings.
ObjectiveTo compare the complication morbidity of mechanical and hand-sewn esophagogastric anastomosis systemically. MethodsMedline (January 1960 to June 2015), EMbase (January 1980 to June 2015), Cochrane Library (January 1996 to June 2015), Web of Science (January 1980 to June 2015) and other databases were searched to identify randomized controlled trials (RCTs) about comparing the complication morbidity of hand-sewn and mechanical anastomosis. Moreover, the references were searched by search engines such as Google Scholar. Papers were screened according to the inclusion and exclusion criteria. And then the data were extracted. The quality of current meta-analysis was assessed by GRADE profiler 3.6 software. The meta-analysis was conducted using Stata 12.0 software. ResultsA total of 1 611 patients in 14 RCTs were reviewed. The results suggested that the anastomatic leakage rate of mechanical method showed no significant difference from that of hand-sewn method[RR=1.07, 95%CI (0.76, 1.51), P=0.699]. While the anastomatic stenosis rate was even higher[RR=1.59, 95%CI (1.21, 2.09), P=0.001]. ConclusionMechanical method can't reduce the anastomotic leakage rate following esophagogastrostomy, while it maybe increase the risk of anastomotic stenosis on the contrary. The patients' physical condition should be considered when surgeons make the choice.
Objective To compare the safety of manual anastomosis and mechanical anastomosis after esophagectomy by meta-analysis. MethodsThe randomized controlled trials (RCTs) about manual anastomosis and mechanical anastomosis after esophagectomy were searched from PubMed, EMbase and The Cochrane Library from inception to January 2018 by computer, without language restrictions. Two authors according to the inclusion and exclusion criteria independently researched literature, extracted data, evaluated bias risk and used R software meta package for meta-analysis. Results Seventeen RCTs were enrolled, including 2 159 patients (1 230 by manual anastomosis and 1 289 by mechanical anastomosis). The results of meta-analysis showed that: (1) there was no significant difference in the incidence of anastomotic leakage between mechanical and manual anastomosis (RR=1.00, 95%CI 0.67–1.48, P=0.181); (2) no significant difference was found in the 30-day mortality (RR=0.95, 95%CI 0.61–1.49, P=0.631); (3) compared with manual anastomosis, the mechanical anastomosis group may increase the risk of anastomotic stenosis (RR=0.74, 95%CI 0.48-1.14, P<0.001). Conclusion Esophageal cancer surgery using a linear or circular stapler can increase the incidence of anastomotic stenosis after surgery. There is no significant difference in the anastomotic leakage and 30-day mortality between manual anastomosis, linear stapler and circular stapler.