Triangulating Stapling Technique Covered with the Pedicled Omental Flap for Esophagogastric Anastomosis: A Safe Anastomosis with Fewer Complications
Triangulating Stapling Technique Covered with the Pedicled Omental Flap for Esophagogastric Anastomosis: A Safe Anastomosis with Fewer Complications
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DOI：
10.1016/j.jamcollsurg.2014.10.015
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发表时间：
2015-02-01
影响因子：
5.2
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
--
作者：
Yoshida, Naoya;Baba, Yoshifumi;Baba, Hideo
食管癌的食管切除术与高发病率相关。食管胃吻合口渗漏和狭窄是食管切除术后最常见的并发症。根据最近对日本全国性网络数据库中5，354例食管切除术的分析，泄漏的频率仍然很高，发生率为13.3%。1例吻合口漏与禁食和住院时间有关。由于相关的吞咽困难，吞咽困难导致术后生活质量下降。此外，两者都有助于增加食管癌治疗期间的经济负担。Toh及其同事最近报告了三角形吻合技术在食管胃吻合术中的有效性。2在他们的文章中，三角形吻合术涉及1例后壁倒置和2例前壁外翻。我们采用这种手术方法，因为它与术后狭窄形成的发生率低。然而，使用该技术时，吻合口漏的发生率略高于环形吻合技术。经常证实在倒置和外翻壁的交叉处发生泄漏（图1）。
Esophagectomy for esophageal cancer is associated with high morbidity. Leaks and strictures of the esophagogastric anastomosis are 2 of the most frequent complications after esophagectomy. According to a recent analysis of 5,354 esophagectomies from a Japanese nationwide web-based database, the frequency of leaks remains high, with an incidence rate of 13.3%. 1 Anastomotic leak prolongs the fasting and hospitalization periods. Stricture results in a deterioration of the quality of life after surgery because of the associated dysphagia. In addition, both contribute to an increased financial burden during the treatment of esophageal cancer. The usefulness of the triangulating stapling technique for esophagogastric anastomoses was recently reported by Toh and colleagues. 2 In their article, the triangulating stapling involved 1 inverted posterior wall and 2 everted anterior walls. We adopted this surgical method because it was associated with a low incidence of postoperative stricture formation. However, with this technique, the incidence of anastomotic leaks was slightly higher than that of a circular stapling technique. Leaks occurring at the intersections of the inverted and everted walls were often confirmed (Figure 1).