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目的通过对食管胃颈部吻合术后并发症的临床分析,探讨胸胃排空障碍发生的原因及防治措施。方法自2000年1月至2008年12月共行食管胃颈部吻合术234例,其中行左颈、左胸二切口者224例,左颈、右胸、腹正中三切口手术者10例。术中采取将胸胃缩缝成管状,尽可能将更多的胃体及胃窦部留在腹腔,术后采取有效胃肠减压等措施。结果本组病例中共发生胸胃排空障碍3例,左颈、左胸二切口手术2例,三切口术后发生1例,其中2例经幽门成形术后治愈,1例保守治疗1周后治愈;对术前经上消化道造影检查发现存在胃动力差而存在排空不良的患者术中附加幽门成形术10例,术后均未发生胸胃排空障碍。结论食管胃颈部吻合术后胃排空障碍发生是多因素的,降低其发生的有效措施有术中采取防止胃扭转、胸胃缩缝成管状、尽可能将更多的胃窦和胃体部留在腹腔,术后采取有效胃肠减压等,术前经上消化道造影检查证实存在胃蠕动无力的患者术中应该附加幽门成形术。
Objective To analyze the causes of esophageal and gastric anastomosis postoperative complications and the prevention and treatment measures. Methods From January 2000 to December 2008, 234 cases of esophagogastrostomy were performed, including 224 cases with two incisions on the left neck and left chest, and 10 cases underwent three incisions on the left neck, right chest and abdomen. Surgery to take the thoracolumbar as a tubular stenosis, as far as possible, more gastric body and gastric antrum in the abdominal cavity, after surgery to take effective gastrointestinal decompression and other measures. Results In this group of patients, there were 3 cases of thoracic gastric emptying disorder, 2 cases left thoracic and 2 cases left thoracic incision, 1 case after 3 incisions, 2 cases were cured after pyloroplasty and 1 case conservative treatment for 1 week Cured; on the preoperative upper gastrointestinal imaging examination found that there is poor gastric motility and poor emptying in patients with pyloroplasty surgery in 10 cases, no postoperative chest emptying disorder. Conclusion Gastroesophageal and gastric anastomosis after gastric emptying disorder is multifactorial, effective measures to reduce its occurrence of surgery to prevent stomach twisting, thoracic and gastric stenosis into the tubular, as much as possible, the more the gastric antrum and body Department stay in the abdominal cavity, postoperative effective gastrointestinal decompression, etc., preoperative upper gastrointestinal imaging confirmed that patients with gastric motility weakness should be attached intraoperative pyloroplasty.