食管连续性重建手术中的挑战。

Challenges in reversing esophageal discontinuity operations.

作者信息

Barkley Christina, Orringer Mark B, Iannettoni Mark D, Yee John

机构信息

University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.

出版信息

Ann Thorac Surg. 2003 Oct;76(4):989-94; discussion 995. doi: 10.1016/s0003-4975(03)00825-7.

DOI:10.1016/s0003-4975(03)00825-7

PMID:14529973

Abstract

BACKGROUND

After catastrophic esophageal or gastric disruption results in esophageal discontinuity, operations to restore swallowing are surgical challenges.

METHODS

A retrospective review and assessment of functional results was performed in 40 patients (average age 59.9 years) who had 42 operations to reverse esophageal discontinuity between 1973 and 2002.

RESULTS

Esophageal discontinuity resulted from gastric necrosis after esophagectomy and esophagogastrostomy (n = 10) or hiatal hernia repair (n = 4), esophageal perforation complicating dilatation (n = 5), failed colonic or jejunal interpositions (n = 5), caustic ingestion (n = 4), Boerhaave syndrome (n = 4), esophagogastric anastomotic leak (n = 3), and other causes (n = 6). Eighteen patients (43.9%) required prolonged mechanical ventilation. Thirty-one (75.6%) had an end cervical esophagostomy; 6, an anterior thoracic esophagostomy; 2, lateral esophagostomy and in situ native esophagus stapled and divided distally; and 1 each, a stapled, divided esophagus without esophagostomy and a stapled undivided esophagus without esophagostomy. Twenty-six patients (63.4%) had undergone partial or total gastrectomy. Ten (24.4%) had vocal cord paralysis. Operations reestablishing continuity included colonic interposition in 23 (56.1%), substernal gastric interposition in 7 (17.1%), esophagectomy and cervical anastomosis in 6, esophageal reanastomosis in 3, staged jejunal interposition in 1, and Roux-en-Y esophagojejunostomy in 1. There were no hospital deaths. Twenty-eight patients (68.3%) had postoperative complications. Length of stay averaged 20.6 days. Follow-up for 40 patients averaged 54.5 months. Functional results (39 patients) were excellent in 12 (30.8%), good in 15 (38.5%), fair in 10 (25.6%), and poor in 2 (5.1%).

CONCLUSIONS

Successful reversal of esophageal discontinuity requires individualized assessment and ingenuity. Despite appreciable morbidity, the ultimate result is generally gratifying.

摘要

背景

在灾难性食管或胃破裂导致食管连续性中断后，恢复吞咽功能的手术是一项外科挑战。

方法

对1973年至2002年间40例（平均年龄59.9岁）接受42次恢复食管连续性手术的患者进行回顾性分析和功能结果评估。

结果

食管连续性中断的原因包括食管切除和食管胃吻合术后胃坏死（n = 10）、食管裂孔疝修补术后（n = 4）、扩张术并发食管穿孔（n = 5）、结肠或空肠间置术失败（n = 5）、腐蚀性物质摄入（n = 4）、Boerhaave综合征（n = 4）、食管胃吻合口漏（n = 3）以及其他原因（n = 6）。18例患者（43.9%）需要长时间机械通气。31例（75.6%）行颈段食管造口术；6例行动脉胸廓段食管造口术；2例行侧方食管造口术，原位食管在远端用吻合器离断；1例食管用吻合器离断但未行食管造口术，1例食管用吻合器离断且未行食管造口术。26例患者（63.4%）接受了部分或全胃切除术。10例（24.4%）有声带麻痹。重建连续性的手术包括结肠间置术23例（56.1%）、胸骨后胃间置术7例（17.1%）、食管切除和颈部吻合术6例、食管再吻合术3例、分期空肠间置术1例、Roux-en-Y食管空肠吻合术1例。无医院死亡病例。2八例患者（68.3%）有术后并发症。平均住院时间为20.6天。40例患者的平均随访时间为54.5个月。功能结果（39例患者）：优12例（30.8%），良15例（38.5%），中10例（25.6%），差2例（5.1%）。