食管胃黏膜延长分层吻合的应用.DOCVIP

临床医学论文-食管胃黏膜延长分层吻合的应用 【摘要】 目的? 探讨食管胃吻合抗胃食管反流的术式。 方法? 选择3年来39例行食管胃黏膜延长分层吻合的病人为研究组，这些病人食管黏膜延长2cm，胃黏膜延长3cm，并分别吻合黏膜层和肌层。选择同期条件相当的46例行全层套入法的病人作对照组，这些病人先行全层吻合，然后再将浆肌层包埋，套入约1.5～2.0cm。分别于术后1～12个月进行对比分析。 结果? 两组在术后早期差异无显著性（P0.05），但随手术后时间的延长，对照组抗反流作用逐渐减弱，黏膜延长分层吻合法与全层套入吻合法抗反流作用相比差异具有显著性。 结论? 适当剥除肌层不会引起黏膜缺血坏死，形成的黏膜瓣薄软，具有良好的抗反流效果。???? 　　关键词? 食管胃吻合 黏膜延长 胃食管反流???? 　　Application of the prolongation-delamination anastomosis of esophagogastric mucous membrance????? 　　Guo Liangjun，Diao Xiujun???? 　　Department of Thoracic Surgery，Peoples Hospital of Yuncheng，Yuncheng274700.??? 　　【Abstract】 Objective To explore the esophagogastric anti-reflux of esophagogastrostomy.Methods 39cases were selected as research group that were given prolongation-delamination anastomosis.The esophagogastric mucous membrane was lengthed by2cm and3cm.Esophagogastric mucous membrane and seromuscular were separately anastomosed layer by layer.The control group was46cases patients who were selected in similar conditions and the same stage，the esophagogastic walls were sutured together，then let1.5～2.0cm esophagus into stomach and sutured their seromuscular layer.All data about gastroesophageal reflux in1to12months after operation were analyzed.Re-sults In the early stage after operation，there was no significant difference in two groups（P0.05）.With the time prolonging，the anti-reflux action in control group was weakened.There was obviously different in two groups（P0.01）.Conclusion To strip the muscular membrane properly does not result in necrosis of the mucous membrane.Because the valve of the mucous membrane shaped is thin and soft，it has the better effects on anti-reflux.??? 　　Key words esophagogastrostomy prolongation of mucous membrane gastroesophageal reflux?????? 　　贲门癌以胃重建食管为常用的手术方法，术后吻合口失去括约肌功能，普遍存在胃食管反流。笔者自2000年2月～2003年6月，为39例贲门癌病人在食管胃吻合中应用食管胃黏膜延长分层吻合法，在抑制病人术后反流中起到了良好的作用。 　　1 资料与方法???? 　　1.1 一般资料 笔者自2000年2月～2003年6月共为39例贲门癌病人在食管胃吻合中应用食管胃黏膜延长分层吻合法，并选择同期常规方法（全层套入法）进行吻合的46例做对比研究，两组情况，见表1。????