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.	盧瑗瑗, 王新, 吳開春.胃食管反流病的診斷流程推薦.臨床消化病雜志, 2008, 20(1):5-8.
2.	鄭衍洪, 黃厚沐, 馬炳太, 等.食管癌術后吻合口狹窄的原因分析.中國現代藥物應用, 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.	韓毓國.胃食管反流性疾病(GERD)胃鏡及病理檢查分析.中國實用醫藥, 2012, 7(11);70-71.
5.	沈禎云, 王可毅, 宋金濤, 等.應用直線型縫合切割器行食管胃側側吻合術.中國現代手術學雜志, 2009, 13(6):434-438.
6.	楊列, 鄭軼峰, 姜建青, 等.食管癌切除術后頸部食管胃側側吻合與手工端側吻合效果的對照研究.重慶醫學, 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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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.	王文憑, 陳龍奇.食管癌外科治療現狀與展望.中國胸心血管外科臨床雜志, 2011, 18(1):58-65.
12.	戴紀剛, 閔家新, 王靜思, 等.帶蒂大網膜瓣袖套式包埋吻合口預防食管癌術后吻合口瘺.重慶醫學, 2012, 41(26):2759-2762.
13.	龐彬, 蘇雪娟, 丁旭青.食管重建術后吻合口瘺的防治現況.中國腫瘤外科雜志, 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.	張燦斌, 李簡, 鄭建, 等.胃管狀成形術在食管重建中的可行性研究.河南科技大學學報, 2005, 23(3):175-179.
16.	張永明, 楊文鋒, 宋平平, 等.食管癌賁門癌切除及食管(管狀胃)胃側側吻合術.中國腫瘤臨床與康復, 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.	孫超, 石維平, 束余聲, 等.管狀胃在食管癌切除術頸部吻合中的應用.中國胸心血管外科臨床雜志, 2012, 19(2):148-150.
19.	趙雍凡, 王資斌, 蔣光亮, 等.切除食管癌兩種消化道重建方式術后胃食管反流的對比觀察.中華胸心血管外科雜志, 1999, 15(3):135-137.
20.	侯朋遠, 吳慶琛.食管癌切除術后管狀胃與全胃代食管的病人生活質量比較.中華胸心血管外科雜志, 2010, 26(4):260-261.
21.	中國抗癌協會食管癌專業委員會編.食管癌規范化診治指南.北京:中國協和醫科大學出版社, 2011, 150.

1. 盧瑗瑗, 王新, 吳開春.胃食管反流病的診斷流程推薦.臨床消化病雜志, 2008, 20(1):5-8.
2. 鄭衍洪, 黃厚沐, 馬炳太, 等.食管癌術后吻合口狹窄的原因分析.中國現代藥物應用, 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. 韓毓國.胃食管反流性疾病(GERD)胃鏡及病理檢查分析.中國實用醫藥, 2012, 7(11);70-71.
5. 沈禎云, 王可毅, 宋金濤, 等.應用直線型縫合切割器行食管胃側側吻合術.中國現代手術學雜志, 2009, 13(6):434-438.
6. 楊列, 鄭軼峰, 姜建青, 等.食管癌切除術后頸部食管胃側側吻合與手工端側吻合效果的對照研究.重慶醫學, 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. 王文憑, 陳龍奇.食管癌外科治療現狀與展望.中國胸心血管外科臨床雜志, 2011, 18(1):58-65.
12. 戴紀剛, 閔家新, 王靜思, 等.帶蒂大網膜瓣袖套式包埋吻合口預防食管癌術后吻合口瘺.重慶醫學, 2012, 41(26):2759-2762.
13. 龐彬, 蘇雪娟, 丁旭青.食管重建術后吻合口瘺的防治現況.中國腫瘤外科雜志, 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. 張燦斌, 李簡, 鄭建, 等.胃管狀成形術在食管重建中的可行性研究.河南科技大學學報, 2005, 23(3):175-179.
16. 張永明, 楊文鋒, 宋平平, 等.食管癌賁門癌切除及食管(管狀胃)胃側側吻合術.中國腫瘤臨床與康復, 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. 孫超, 石維平, 束余聲, 等.管狀胃在食管癌切除術頸部吻合中的應用.中國胸心血管外科臨床雜志, 2012, 19(2):148-150.
19. 趙雍凡, 王資斌, 蔣光亮, 等.切除食管癌兩種消化道重建方式術后胃食管反流的對比觀察.中華胸心血管外科雜志, 1999, 15(3):135-137.
20. 侯朋遠, 吳慶琛.食管癌切除術后管狀胃與全胃代食管的病人生活質量比較.中華胸心血管外科雜志, 2010, 26(4):260-261.
21. 中國抗癌協會食管癌專業委員會編.食管癌規范化診治指南.北京:中國協和醫科大學出版社, 2011, 150.

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

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