Kuwabara Y, Sato A, Mitani M, Shinoda N, Hattori K, Suzuki T, Fujii Y
Department of Surgery II, Nagoya City University Medical School, Japan.
Ann Thorac Surg. 2001 Feb;71(2):409-13. doi: 10.1016/s0003-4975(00)02228-1.
Carcinomas of the cervicothoracic esophagus frequently invade the trachea and complete removal of the tumor often requires mediastinal tracheostomy. Traditionally, this surgical management was associated with high morbidity and mortality. Several types of myoctaneous flaps have been used for mediastinal tracheostomy to reduce the complication. We present our experience with a new technique for construction of mediastinal tracheotomy after total laryngoesophagectomy and reconstruction with the stomach.
The anterior chest wall was amply resected and the distal end of the trachea was placed low between the superior vena cava and aortic arch. We mobilized the entire omentum with the stomach and brought them up to the neck through the posterior mediastinum. The omentum was put around the trachea, main arteries, and the anastomosis.
Seven mediastinal tracheostomies were performed using this method. There was no hospital death. Complications included respiratory failure (2 patients) and pyothorax (1 patient). Anastomotic leakage and inominate artery rupture were not experienced. Postoperative survival was disease dependent. All patients were discharged with satisfactory oral food intake, good airway condition, and excellent cosmetic appearance.
We suggest the use of the omentum as a simple and reliable technique in constructing mediastinal tracheostomy following total laryngoesophagectomy for cervicothoracic esophageal cancer.
颈段与胸段食管交界处的癌肿常侵犯气管，完整切除肿瘤往往需要进行纵隔气管造口术。传统上，这种手术治疗方式的发病率和死亡率较高。几种肌皮瓣已被用于纵隔气管造口术以减少并发症。我们介绍了在全喉食管切除及胃重建术后构建纵隔气管切开术的一种新技术的经验。
充分切除前胸壁，将气管远端置于上腔静脉和主动脉弓之间的低位。我们将整个网膜与胃一起游离，并通过后纵隔将它们提至颈部。将网膜置于气管、主要动脉及吻合口周围。
使用该方法进行了7例纵隔气管造口术。无医院死亡病例。并发症包括呼吸衰竭（2例患者）和脓胸（1例患者）。未发生吻合口漏和无名动脉破裂。术后生存情况取决于疾病。所有患者出院时经口进食情况良好、气道状况良好且外观美观。
我们建议在颈段与胸段食管癌全喉食管切除术后构建纵隔气管造口术时，使用网膜作为一种简单可靠的技术。
