Comparison between layered anastomosis and mechanical anastomosis of tubular stomach and cervical esophagus in esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LI Junyan , WANG Yong , LIU Weiliang , XU Jianhua , LI Huajun

Department of Cardiothoracic Surgery, 3201 Hospital, Xi'an Jiaotong University, Hanzhong, Shanxi 723000, P.R.China;

Corresponding?author：

LI Junyan, Email: lijunyan_2004@163.com

Keywords：

Tubular stomach; layered anastomosis; esophageal cancer; esophagectomy

DOI：

10.7507/1007-4848.201604006

Video：

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Objective To compare the outcome of tubular stomach and cervical esophagus laminated anastomosis and mechanical anastomosis. Methods A total of 128 patients with middle and upper esophageal cancer in our hospital from January 2013 to January 2016 were randomly divided into two groups, 64 patients in each group and all patients underwent esophagectomy. In the group A, there were 46 males and 18 females with age of 40–75 years, treated with tubular stomach and cervical esophagus layered anastomosis. There were 51 males and 13 females with age of 43–71 years in the group B receiving mechanical anastomosis. We observed the short-term and long-term efficacy as well as complications. Results In the group A, there was cervical anastomotic fistula in 1 patient, anastomotic stenosis in 2 patients and reflux esophagitis in 12 patients. In the group B, 1 patient suffered chylothorax, 8 patients cervical anastomotic fistula, 4 patients anastomotic stenosis and 14 patients reflux esophagitis. Conclusion Layered anastomosis can effectively reduce the incidence of anastomotic fistula and stenosis. Tubular stomach can effectively prevent and reduce the reflux esophagitis, and the high long-term quality of life will be achieved after the operation.

Citation： LIJunyan, WANGYong, LIUWeiliang, XUJianhua, LIHuajun. Comparison between layered anastomosis and mechanical anastomosis of tubular stomach and cervical esophagus in esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(1): 61-64. doi: 10.7507/1007-4848.201604006 Copy

1.	?楊列, 鄭軼峰, 姜建青, 等. 不同食管胃吻合方式對術后并發癥影響的 Meta 分析. 循證醫學, 2013, 13(3): 173-180.
2.	Stein HJ, Sendler A, Fink U, et al. Multidisciplinary approach to esophageal and gastric cancer. Surg Clin North Am, 2000, 80(2): 659-682.
3.	龔太乾, 蔣耀光, 王如文, 等. 食管癌術后早期并發癥及死亡原因分析. 中國胸心血管外科臨床雜志, 2005, 12(3): 173-176.
4.	劉奎, 魏煜程. 食管吻合口瘺診療進展. 醫學綜述, 2012, 18(8): 1191-1104.
5.	Hu Z, Yin R, Fan X , et al. Treatment of intrathoracic anastomotic leak by nose fistula tube drainage after esophagectomy for cancer. Dis Esophagus, 2011, 24(2): 100-107.
6.	Kim RH, Takabe K. Methods of esophagogastric anastomoses following esophagectomy for cancer: a systematic review. J Surg Oncol, 2010, 101(6): 527-533.
7.	田燁, 周凌霄, 任光國. 1208 例食管癌患者術后吻合瘺風險因素分析. 重慶醫學, 2014, 43(15): 1924-1926.
8.	楊光明, 孟鑌, 張智, 等. 食管癌術后吻合口瘺防治的臨床分析. 局解手術學雜志, 2009, 18(3): 185.
9.	張志庸, 李單青, 崔玉荷, 等. 食管賁門癌切除器械吻合術 519 例. 中國胸心血管外科臨床雜志, 2001, 8(3): 197-198.
10.	Takala H, Saarnio J, Wiik H, et al. HIF-Iα and VEGF are associated with disease progression in esophageal carcinoma. Surg Res, 2011, 167(1): 41-48.
11.	陳傳波, 路雪芹, 鄭蘭東, 等. 食管胃黏膜延長分層吻合的實驗研究. 中國胸心血管外科臨床雜志, 2002, 9(3): 201-204.
12.	Parekh K, Iannettoni MD. Complications of esophageal resection and reconstruction. Semin Thorac Cardiovasc Surg, 2007,19(1): 79-88.
13.	解晨浩, 趙雍凡, 寇瑛俐, 等. 食管胃分層吻合法吻合口愈合質量的實驗研究. 中華胸心血管外科雜志, 2004, 20(5): 261-263.
14.	趙雍凡, 解晨昊, 王允, 等. 食管胃分層吻合法的應用與實驗觀察. 中國胸心血管外科臨床雜志, 2005,12(3): 164-168.
15.	Jemal A, Bray F, Center MM, et al. Global cancer statistic. CA Cancer J Clin, 2011, 61(2): 69-90.
16.	Yamamoto S, Makuuchi H, Shimada H, et al. Clinical analysis of reflux esophagitis following esophagectomy with gastric tube reconstruction. J Gastroenterol, 2007, 42(5): 342-345.
17.	張思維, 張敏, 李光琳, 等. 2003～2007 年中國食管癌發病與死亡分析. 中國腫瘤, 2012, 21(4): 241-247.
18.	Pech O, Günter E, Dusemund F, et al. Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer. Endoscopy, 2010, 42(6): 456-461.
19.	Kim HK, Choi YH, Shim JH, et al. Endoscopic evaluation of the quality of the anastomosis after esophagectomy with gastric tube reconstruction. World J Surg, 2008, 32(9): 2010-2014.
20.	Heitmiller RF. Impact of gastric tube diameter on upper mediastinal anatomy after transhiatal esophagectomy. Dis Esophagus, 2000,13(4): 288-292.

1. ?楊列, 鄭軼峰, 姜建青, 等. 不同食管胃吻合方式對術后并發癥影響的 Meta 分析. 循證醫學, 2013, 13(3): 173-180.
2. Stein HJ, Sendler A, Fink U, et al. Multidisciplinary approach to esophageal and gastric cancer. Surg Clin North Am, 2000, 80(2): 659-682.
3. 龔太乾, 蔣耀光, 王如文, 等. 食管癌術后早期并發癥及死亡原因分析. 中國胸心血管外科臨床雜志, 2005, 12(3): 173-176.
4. 劉奎, 魏煜程. 食管吻合口瘺診療進展. 醫學綜述, 2012, 18(8): 1191-1104.
5. Hu Z, Yin R, Fan X , et al. Treatment of intrathoracic anastomotic leak by nose fistula tube drainage after esophagectomy for cancer. Dis Esophagus, 2011, 24(2): 100-107.
6. Kim RH, Takabe K. Methods of esophagogastric anastomoses following esophagectomy for cancer: a systematic review. J Surg Oncol, 2010, 101(6): 527-533.
7. 田燁, 周凌霄, 任光國. 1208 例食管癌患者術后吻合瘺風險因素分析. 重慶醫學, 2014, 43(15): 1924-1926.
8. 楊光明, 孟鑌, 張智, 等. 食管癌術后吻合口瘺防治的臨床分析. 局解手術學雜志, 2009, 18(3): 185.
9. 張志庸, 李單青, 崔玉荷, 等. 食管賁門癌切除器械吻合術 519 例. 中國胸心血管外科臨床雜志, 2001, 8(3): 197-198.
10. Takala H, Saarnio J, Wiik H, et al. HIF-Iα and VEGF are associated with disease progression in esophageal carcinoma. Surg Res, 2011, 167(1): 41-48.
11. 陳傳波, 路雪芹, 鄭蘭東, 等. 食管胃黏膜延長分層吻合的實驗研究. 中國胸心血管外科臨床雜志, 2002, 9(3): 201-204.
12. Parekh K, Iannettoni MD. Complications of esophageal resection and reconstruction. Semin Thorac Cardiovasc Surg, 2007,19(1): 79-88.
13. 解晨浩, 趙雍凡, 寇瑛俐, 等. 食管胃分層吻合法吻合口愈合質量的實驗研究. 中華胸心血管外科雜志, 2004, 20(5): 261-263.
14. 趙雍凡, 解晨昊, 王允, 等. 食管胃分層吻合法的應用與實驗觀察. 中國胸心血管外科臨床雜志, 2005,12(3): 164-168.
15. Jemal A, Bray F, Center MM, et al. Global cancer statistic. CA Cancer J Clin, 2011, 61(2): 69-90.
16. Yamamoto S, Makuuchi H, Shimada H, et al. Clinical analysis of reflux esophagitis following esophagectomy with gastric tube reconstruction. J Gastroenterol, 2007, 42(5): 342-345.
17. 張思維, 張敏, 李光琳, 等. 2003～2007 年中國食管癌發病與死亡分析. 中國腫瘤, 2012, 21(4): 241-247.
18. Pech O, Günter E, Dusemund F, et al. Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer. Endoscopy, 2010, 42(6): 456-461.
19. Kim HK, Choi YH, Shim JH, et al. Endoscopic evaluation of the quality of the anastomosis after esophagectomy with gastric tube reconstruction. World J Surg, 2008, 32(9): 2010-2014.
20. Heitmiller RF. Impact of gastric tube diameter on upper mediastinal anatomy after transhiatal esophagectomy. Dis Esophagus, 2000,13(4): 288-292.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison between layered anastomosis and mechanical anastomosis of tubular stomach and cervical esophagus in esophagectomy

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