Sueyoshi S, Yamana H, Fujita H, Tanaka T, Toh U, Kubota M, Tanaka Y, Mine T, Sasahara H, Shirouzu K
Department of Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume 830-0011, Japan.
Jpn J Thorac Cardiovasc Surg. 2000 Nov;48(11):683-7. doi: 10.1007/BF03218232.
We have often conducted esophageal reconstruction via a thoracic subcutaneous route in high-risk patients to avoid major complications following anastomotic leakage. This type of reconstruction is nonphysiological, however, and presents a poor cosmetic appearance. In better risk patients, therefore, we usually conduct gastric-tube replacement via a posterior mediastinal route. We have recently begun gastric-tube replacement via the posterior mediastinal route with secondary anastomosis for high-risk patients to avoid anastomotic leakage.
From 1996 to 1999, secondary anastomosis was conducted in 25 patients with different degrees of risk--10 with diabetes mellitus, 7 with liver dysfunction, 3 with simultaneous laryngeal and/or pharyngeal cancer, 2 each with induction chemoradiotherapy, cardiac failure, renal dysfunction, respiratory failure, and cardiorespiratory dysfunction, and 1 with cerebral infarction. 6 patients had with multiple combined diseases. Secondary anastomosis was conducted 3-12 weeks (mean: 5.5 weeks) after esophagectomy. Stomach-tube necrosis was not seen in any of the 25 patients undergoing this 2-step procedure. Anastomosis leakage was seen in 5 of the 25 patients (20%), but was slight, in all but 1.
Our 2-step procedure has the following advantages: low risk of anastomotic leakage, radical surgery for esophageal cancer, the potential for early adjuvant therapy after esophagectomy, easy and early training in swallowing, and no cosmetic problem. Its disadvantages are prolonged hospitalization, multiple surgery, and esophageal stoma formation. Secondary anastomosis thus appears helpful in treating high-risk patients with advanced esophageal cancer.
我们经常通过胸段皮下途径对高危患者进行食管重建，以避免吻合口漏后出现严重并发症。然而，这种重建方式不符合生理状态，且外观不佳。因此，对于风险较低的患者，我们通常通过后纵隔途径进行胃管置换。最近，我们开始对高危患者采用后纵隔途径进行胃管置换并二期吻合，以避免吻合口漏。
1996年至1999年，对25例不同风险程度的患者进行了二期吻合——10例患有糖尿病，7例肝功能不全，3例同时患有喉和/或咽癌，2例分别接受诱导放化疗、心力衰竭、肾功能不全、呼吸衰竭和心肺功能不全，1例患有脑梗死。6例患者患有多种合并症。二期吻合在食管切除术后3至12周（平均：5.5周）进行。在接受此两步手术的25例患者中，均未出现胃管坏死。25例患者中有5例（20%）出现吻合口漏，但除1例严重外，其余均较轻微。
我们这种两步手术具有以下优点：吻合口漏风险低、食管癌根治性手术、食管切除术后有早期辅助治疗的可能性、吞咽训练简便且早期可进行、无外观问题。其缺点是住院时间延长、多次手术以及形成食管造口。因此，二期吻合似乎有助于治疗高危的晚期食管癌患者。
