食管癌切除颈部食管与胃吻合手术方法的改进(附99例报告)

食管癌切除,颈部食管、胃吻合过去采用直接在颈部解剖、游离食管、拉胃和食管包套的方法进行吻合。喉返神经损伤、吻合口瘘、吻合口狭窄的发生率高。作者用改进的方法对99例食管癌作了食管胃吻合。在胸锁乳突肌内缘切开皮肤、皮下组织后,颈前肌群在术者从胸内伸至颈部的手指的引导下切开,这样就避开了喉返神经。然后提拉胃粘膜下血管的缝扎线,胃可轻易提至颈部,胃的血运好。加之食管、胃前壁是单层吻合,所以术后并发症的发生率明显减少。改进的手术方法简单安全,易掌握,具有一定的实用价值。

THE IMPROVING METHOD OF THE CONNECTION OPERATION OF NECK ESOPHAGUS WITH STOMACH FOR THE RESECTION OF THE ESOPHAGUS CANCER (ATTACHED WITH 99 CASE REPORTS)

For the resection of the esophagus cancer the neck esophagus and stomach were used to be connected by directly dissecting the neck,separation the esophagus, pulling the stomach and covering the esophagus. The occurrence rates of the injury of larynges nerves, incision fistula and stricture were very high. The authors adopted an improving method of neck connection op-eration for 99 cases of the esophagus cancer. First, after incising the skin and subcutaneous tissue along the inner side of strn-ocleidomastoid muscle, the muscles of the neck are incised from the patient's chest to neck under the guidance of the surgeon's finger. By this way, the larynges nerves are avoided. Then, pull the suture of the blood vessel under the stomach mucous mem-brane, the stomach can be easily pulled to the neck. The blood circulation keeps good. Besides, the front wall of the esophagus and stomach are connected on one side, so the occurrence rate of complications is obviously reduced. This improving operation methodis very simple, safe and easy to master. It's value is useful.