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右结肠成形术行咽食管成形术治疗腐蚀性咽喉食管烧伤:附13例报告

[Pharyngo-esophagoplasty by right coloplasty for the treatment of post-caustic pharyngo-laryngeal-esophageal burns: a report of 13 cases].

作者信息

Brette M, Aidan K, Halimi B, Cattan P, Grozier F, Sarfati E, Monteil J

机构信息

Service d'ORL et chirurgie maxillo-faciale, Hôpital Saint Louis, 1, avenue Claude Vellefaux, 75010 Paris.

出版信息

Ann Otolaryngol Chir Cervicofac. 2000 Jun;117(3):147-54.

Abstract

We report a new technique of pharyngoesophagoplasty by right coloplasty, indicated in postcaustic severe pharyngeal stenosis, analyzing the anatomical and functional results in terms of respiratory tract and phonation as well as digestive tract outcome. We compared our results with those obtained with other procedures. Between March 1995 and September 1998, pharyngoesophagoplasty by right coloplasty was performed in 13 patients. All had severe hypopharyngeal stricture with total obliteration of the two piriform sinuses and the upper esophageal sphincter. Nine patients underwent emergency esophagectomy or esogastrectomy by stripping and four had a cicatricial esophagus. Eight patients underwent tracheotomy before the pharyngoplasty due to burns of the laryngeal margin or airway infections. There was no perioperative mortality. The retrospective analysis in February 1998 with a follow-up of 22 months disclosed two deaths, one from septic shock following pneumnia and one suicide. For the 11 other patients, respiratory function had been restored successfully as the tracheostomy tube had been removed. Eight of the patients were on regular oral diet and the jejunostomy tube had been removed. Three had mild dysphagia and the oral diet was supplemented by jejunostomy tube feedings. These results were most successful compared with those obtained with 29 other patients. Pharyngo-esophagoplasty by right colonic transposition appears to be the method of choice for the reconstruction of post-caustic pharyngeal and esophageal stenosis.

摘要

我们报告一种通过右结肠成形术进行咽食管成形术的新技术,该技术适用于腐蚀性严重咽狭窄,从呼吸道、发声以及消化道结局方面分析其解剖学和功能结果。我们将我们的结果与通过其他手术获得的结果进行了比较。1995年3月至1998年9月期间,对13例患者实施了通过右结肠成形术进行的咽食管成形术。所有患者均患有严重的下咽狭窄,双侧梨状窝和食管上括约肌完全闭塞。9例患者因剥脱术接受了急诊食管切除术或食管胃切除术,4例患者患有瘢痕性食管。8例患者因喉缘烧伤或气道感染在咽成形术前接受了气管切开术。围手术期无死亡病例。1998年2月进行的回顾性分析,随访22个月,发现2例死亡,1例死于肺炎后感染性休克,1例自杀。对于其他11例患者,由于气管造口管已拔除,呼吸功能已成功恢复。8例患者能正常经口饮食,空肠造瘘管已拔除。3例有轻度吞咽困难,经口饮食需辅以空肠造瘘管喂养。与其他29例患者获得的结果相比,这些结果最为成功。通过右结肠移位进行咽食管成形术似乎是重建腐蚀性咽和食管狭窄的首选方法。

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