目的 探讨圆形吻合器在高龄贲门胃底癌经腹切除术中的应用。方法 回顾性分析1999年1月至2009年5月期间在我院接受圆形吻合器经腹切除术的238例70岁以上高龄贲门胃底癌患者的临床资料，并对围手术期结果进行分析。 结果 全组手术时间3～4.5 h，平均3.5 h。出血量50～1 000 ml，平均300 ml。术中并发大出血1例，给予积极止血，无术中死亡。所有病例机械吻合术后未出现吻合口漏。术后60例患者（25%）出现不同程度的并发症，其中吻合口出血2例, 左侧胸腔积液13例，肺部感染15例, 心衰3例, 肺不张2例, 心律失常10例，右侧胸腔积液15例。无围手术期死亡。术后随访3年，出现返流性食管炎45例，吻合口狭窄30例，无吻合口肿瘤复发，3年生存率为64%(152/238)。结论 应用圆形吻合器在高龄胃底贲门癌患者经腹切除术是安全、有效的。
目的：探讨食道癌贲门癌术后两种重建方法的优劣。方法：实验组食管癌贲门癌切除术后采用圆形吻合器行食管胃器械吻合，吻合口4号丝线间断加强并另行吻合口大网膜缠绕并吻合合口减张。对照组行食管胃粘膜及粘膜下分层吻合加胃浆肌层与食管肌层缝合包埋吻合口并减张重建。比较两组手术时间，术后肺部感染和肺不张、吻合口瘘和狭窄及胃食管反流发生率。结果：实验组吻合口瘘发生率为0.6%（2/316），吻合口狭窄发生率为5.7%（18/316），对照组吻合口瘘发生率为1.6%（3/186），吻合口狭窄发生率为4.3%（8/186），均有显著性差异（P＜0.05）。吻合口近端胃食管反流液随机抽样检查pH值，差异无统计学意义（P＞0.05）。行机械吻合手术时间明显缩短，有统计学意义（P＜0.05）。实验组肺部感染发生率0.3%（1/316），无肺不张，对照组肺部感染发生率1.6%（3/186），肺不张0.5%（1/186），其差异有统计学意义（P＜0.05）。结论：食管癌贲门癌切除术中行机械吻合重建方便快捷，可减少并发症，适于临床临床推广。
目的 评价采用圆形吻合器治疗直肠黏膜脱垂的安全性和可行性. 方法 回顾性分析2002年10月至2006年1月我院手术治疗的42例直肠黏膜脱垂患者的临床资料,其中直肠内黏膜脱垂22例,直肠外黏膜脱垂20例,均经排粪造影诊断. 结果 42例均行经肛门直肠黏膜环切术(procedure for prolapse and haemorrhoids,PPH),术后随访2～40个月,2例术后半年少量便血,肠镜检查为吻合口丝线缝合处肉芽生长所致.总有效率为88.1%(37/42),其中直肠内黏膜脱垂有效率为81.8%(18/22),直肠外黏膜脱垂有效率达95.0%(19/20). 结论 PPH术治疗直肠外黏膜脱垂优于直肠内黏膜脱垂,手术简便.
ObjectiveTo explore the application effects of hand-sewn layered anastomosis (HS) and circular stapled anastomosis (CS) in inflatable mediastinal mirror synchronous laparoscopic radical esophagectomy for esophageal cancer. MethodsPatients who underwent inflatable mediastinal mirror synchronous laparoscopic radical esophagectomy for esophageal cancer in Huaihe Hospital of Henan University from 2018 to 2019 were retrospectively included. Patients were divided into a HS group and a CS group according to the anastomosis methods, and propensity score matching was used to match patients at a ratio of 1:1. The baseline clinical characteristics, perioperative indicators, CD4+/CD8+ immune index comparison, pain, various lung function indicators, incidence of short-term and long-term postoperative complications, and quality of life were compared between the two groups. ResultsA total of 153 patients were included, including 108 males and 45 females, with an average age of (61.81±5.18) years. After propensity score matching, 70 patients were included in each group. Compared with the CS group, the operation time was longer in the HS group [(107.10±8.25) min vs. (97.65±6.85) min, P<0.001]; the CD4+/CD8+ level was lower in the HS group 1-3 days after surgery; the pain score was higher, and various lung function indicators (forced expiratory volume in the first second, forced vital capacity, and one-second rate) were lower in the HS group 1-7 days after surgery; within 6 months after surgery, the incidence of anastomosis-related complications (anastomotic stenosis, anastomotic fistula, and gastroesophageal reflux) was lower in the HS group; and the quality of life score was higher in the HS group from 14 days to 6 months after surgery (P<0.05). ConclusionHS can reduce the incidence of postoperative anastomotic fistula, anastomotic stenosis, and gastroesophageal reflux, and improve the short-term quality of life of patients, but it has a longer operation time, more intense short-term postoperative pain, and may affect the early recovery of lung function. HS and CS are complementary, and the appropriate surgical method should be chosen according to the individual situation of the patient to achieve the maximum clinical benefit.