식도-공장 문합법으로 위 전절제술 후 고정 봉합의 효능

Abstract

Background and Purpose : Esophagojejunostomy after total gastrectomy shows high mortality and morbidity compared to other intestinal anastomotic methods. The complication after esophagojejunostomy is thought to be caused by constant tension on esophagojejunostomy in human erect position which results in disturbance of blood flow in anastomotic site. The purpose of this study is to evaluate efficacy of anchoring sutures used to fix the esophagojejunostomy site to diaphragm for artificial restoration of phrenoesophageal ligament. Materiasl and Methods : From January 1998 to December 2008, Medical charts of patients which diagnosed with gastric cancer and consecutively underwent total gastrectomy at the Chosun University Hospital were analyzed retrospectively. All patients were performed anchoring suture between jejunum and diaphregm after esphagojejunostomy. Esophagogram was used to check the leakage of anastomosis at 5 days after operation and follow-up esophagoscopy 6 months to rule out anastomotic stenosis. Results : From January 1998 to December 2008, 171 patients consecutively underwent total gastrectomy. In Finally, 155 patients were inrolled in this study. Ruexen-Y anastomosis 126 patients, jejunal interposition 29 patients. Esophagojejunostomy leakage 3 patients, revision operation 2 patients, conservation 1 patient. Esophagojejunostomy stenosis 1 patient which was improved by EGD balloon procedure. Conclusion : Anchoring suture of jejunum distal to esophagojejunostomy to diaphragm after total gastrectomy partially recovers phrenoesophageal ligament. This procedure is thought to protect esophagojejunostomy site from traction force.