Complete Mechanical Cervical Side-to-side Esophago-gastric Tube Anastomosis in 60 Patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOUAi-Xiang ¹ , LILing ² ,  LIBao-tian ¹ , LIUGao-feng ¹ , LIDan-dan ¹ , QINYun-liang ³ , LVZhi-min ⁴

1. Department of Cardiothoracic Surgery, The 153 rd Central Hospital of People's Liberation Army, Zhengzhou 450042, P. R. China;
2. Information Center of Land Bureau of Henan Province, Zhengzhou 450042, P. R China;
3. Department of Cardiothoracic Surgery, Anyang Sixth People's Hospital, Anyang 455002, Henan, P. R. China;
4. Department of Thoracic Surgery, Xinzheng People's Hospital, Xinzheng 450062, Henan, P. R China;

Corresponding author：

LIBao-tian, Email: lbting292@sina.com

Keywords：

Esophageal cancer; Cervical anastomosis; Gastric tube; Side-to-side; mechanical anastomosis; Gastroesophageal reflux

DOI：

10.7507/1007-4848.20140184

Video：

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Objective To explore clinical outcomes of complete mechanical cervical side-to-side esophago-gastric tube anastomosis. Methods Clinical 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. Results All 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. Conclusion Complete mechanical cervical side-to-side esophago-gastric tube anastomosis can significantly prevent anastomotic stenosis, leak and intrathoracic stomach symptoms with good clinical outcomes.

Citation： ZHOUAi-Xiang, LILing, LIBao-tian, LIUGao-feng, LIDan-dan, QINYun-liang, LVZhi-min. Complete Mechanical Cervical Side-to-side Esophago-gastric Tube Anastomosis in 60 Patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 644-647. doi: 10.7507/1007-4848.20140184 Copy

1.	卢瑗瑗, 王新, 吴开春.胃食管反流病的诊断流程推荐.临床消化病杂志, 2008, 20(1):5-8.
2.	郑衍洪, 黄厚沐, 马炳太, 等.食管癌术后吻合口狭窄的原因分析.中国现代药物应用, 2012, 6(6):18-19.
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5.	沈祯云, 王可毅, 宋金涛, 等.应用直线型缝合切割器行食管胃侧侧吻合术.中国现代手术学杂志, 2009, 13(6):434-438.
6.	杨列, 郑轶峰, 姜建青, 等.食管癌切除术后颈部食管胃侧侧吻合与手工端侧吻合效果的对照研究.重庆医学, 2012, 41(30):3155-3159.
7.	Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer:a prospective randomized controlled trial. Ann Surg, 1997, 226(2):169-173.
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10.	Raz DL, Tedeseo P, Herbella FA, et al. Side-to-side stapled intra-thorcic esophagogastric anastomosis reduces the incidence of leaks and stenosis. Dis Esophagus, 2008, 21(1):69-72.
11.	王文凭, 陈龙奇.食管癌外科治疗现状与展望.中国胸心血管外科临床杂志, 2011, 18(1):58-65.
12.	戴纪刚, 闵家新, 王静思, 等.带蒂大网膜瓣袖套式包埋吻合口预防食管癌术后吻合口瘘.重庆医学, 2012, 41(26):2759-2762.
13.	庞彬, 苏雪娟, 丁旭青.食管重建术后吻合口瘘的防治现况.中国肿瘤外科杂志, 2012, 4(1):51-53.
14.	Orringer MB, Marshall B, Lannetton, MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorc Cardiovasc Surg, 2000, 119(2):277-288.
15.	张灿斌, 李简, 郑建, 等.胃管状成形术在食管重建中的可行性研究.河南科技大学学报, 2005, 23(3):175-179.
16.	张永明, 杨文锋, 宋平平, 等.食管癌贲门癌切除及食管(管状胃)胃侧侧吻合术.中国肿瘤临床与康复, 2011, 18(2):175-178.
17.	Cooke DT, Lin GC, Lau CL, et al. Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy:risk factors, presentation, and detection. Ann Thorac Surg, 2009, 88(1):177-185.
18.	孙超, 石维平, 束余声, 等.管状胃在食管癌切除术颈部吻合中的应用.中国胸心血管外科临床杂志, 2012, 19(2):148-150.
19.	赵雍凡, 王资斌, 蒋光亮, 等.切除食管癌两种消化道重建方式术后胃食管反流的对比观察.中华胸心血管外科杂志, 1999, 15(3):135-137.
20.	侯朋远, 吴庆琛.食管癌切除术后管状胃与全胃代食管的病人生活质量比较.中华胸心血管外科杂志, 2010, 26(4):260-261.
21.	中国抗癌协会食管癌专业委员会编.食管癌规范化诊治指南.北京:中国协和医科大学出版社, 2011, 150.

1. 卢瑗瑗, 王新, 吴开春.胃食管反流病的诊断流程推荐.临床消化病杂志, 2008, 20(1):5-8.
2. 郑衍洪, 黄厚沐, 马炳太, 等.食管癌术后吻合口狭窄的原因分析.中国现代药物应用, 2012, 6(6):18-19.
3. Aframian DJ, Ofir M, Benoliel R. Comparison of oral mucosal pH values in bulimia nervosa, GERD, BMS patients and healthy population. Oral Dis, 2010, 16(8):807-811.
4. 韩毓国.胃食管反流性疾病(GERD)胃镜及病理检查分析.中国实用医药, 2012, 7(11);70-71.
5. 沈祯云, 王可毅, 宋金涛, 等.应用直线型缝合切割器行食管胃侧侧吻合术.中国现代手术学杂志, 2009, 13(6):434-438.
6. 杨列, 郑轶峰, 姜建青, 等.食管癌切除术后颈部食管胃侧侧吻合与手工端侧吻合效果的对照研究.重庆医学, 2012, 41(30):3155-3159.
7. Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer:a prospective randomized controlled trial. Ann Surg, 1997, 226(2):169-173.
8. Willias VA, Walson TJ, Zhovtis S, et al. Endoscopic and symptomatic assessment of anastom otic strictures following esophagectomy and cervical esophagogastrostomy. Surg Endose, 2008, 22(6):1470-1476.
9. Davies AR, Forshaw MJ, Khan AA, et al. Transhiatal esophagectomy in a high volume institution. World J Surg Oncol, 2008, 6(1):88.
10. Raz DL, Tedeseo P, Herbella FA, et al. Side-to-side stapled intra-thorcic esophagogastric anastomosis reduces the incidence of leaks and stenosis. Dis Esophagus, 2008, 21(1):69-72.
11. 王文凭, 陈龙奇.食管癌外科治疗现状与展望.中国胸心血管外科临床杂志, 2011, 18(1):58-65.
12. 戴纪刚, 闵家新, 王静思, 等.带蒂大网膜瓣袖套式包埋吻合口预防食管癌术后吻合口瘘.重庆医学, 2012, 41(26):2759-2762.
13. 庞彬, 苏雪娟, 丁旭青.食管重建术后吻合口瘘的防治现况.中国肿瘤外科杂志, 2012, 4(1):51-53.
14. Orringer MB, Marshall B, Lannetton, MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorc Cardiovasc Surg, 2000, 119(2):277-288.
15. 张灿斌, 李简, 郑建, 等.胃管状成形术在食管重建中的可行性研究.河南科技大学学报, 2005, 23(3):175-179.
16. 张永明, 杨文锋, 宋平平, 等.食管癌贲门癌切除及食管(管状胃)胃侧侧吻合术.中国肿瘤临床与康复, 2011, 18(2):175-178.
17. Cooke DT, Lin GC, Lau CL, et al. Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy:risk factors, presentation, and detection. Ann Thorac Surg, 2009, 88(1):177-185.
18. 孙超, 石维平, 束余声, 等.管状胃在食管癌切除术颈部吻合中的应用.中国胸心血管外科临床杂志, 2012, 19(2):148-150.
19. 赵雍凡, 王资斌, 蒋光亮, 等.切除食管癌两种消化道重建方式术后胃食管反流的对比观察.中华胸心血管外科杂志, 1999, 15(3):135-137.
20. 侯朋远, 吴庆琛.食管癌切除术后管状胃与全胃代食管的病人生活质量比较.中华胸心血管外科杂志, 2010, 26(4):260-261.
21. 中国抗癌协会食管癌专业委员会编.食管癌规范化诊治指南.北京:中国协和医科大学出版社, 2011, 150.

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Complete Mechanical Cervical Side-to-side Esophago-gastric Tube Anastomosis in 60 Patients

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