식도절제후 위를 이용한 재건술

Esophagogastrostomy has become the accepted procedure of the reconstruction following resection for the esophageal carcinoma. But it has serious complication of anastomotic leakage about 10% that was thought to be responsible for more than half of the postoperative deaths. Recently the incidence of this complication decreased to about 3.5% after using the stapling instrument. 17 patients, who received esophagogastrostomy after esophagectomy due to carcinoma and lye stricture of the esophagus, from the January 1977 to October 1986 at Department of Surgery, Yonsei University College of Medicine. The results were as followed. 1) The manual anastomosis was performed in 11 cases and the stapled anastomosis in 6 cases. 2) The operative mortality was 5.9% 3) The complications of manual anastomosis were; anastomotic leakage in 2 cases (18%), stricture in anastomotic site in 3 cases (27%), pneumonia in 3 cases (27%), gastroesophageal reflux in 1 case (9%) and wound infection in 1 case (9%). The transhiatal esophagectomy was performed in 3 cases and the complications of this procedure were bleeding and pneumothorax in 1 case. 4) The complications of stapled anastomosis were; pneumonia in 2 cases (33%), stricture in anastomotic site in 1 case (17%) and wound infection in 1 case (17%). The leakage from the anastomotic site was not found. As substitute for esophagus, stomach is advantageous for it's simplicity, and excellent blood supply. And the stapled anastomosis appears to be safer than manual suturing for patients undergoing esophageal reconstruction.