Renzulli Pietro, Joeris Alexander, Strobel Oliver, Hilt Annemarie, Maurer Christoph A, Uhl Waldemar, Büchler Markus W
Department of Visceral and Transplantation Surgery, University of Berne, Inselspital, Switzerland.
Langenbecks Arch Surg. 2004 Apr;389(2):128-33. doi: 10.1007/s00423-003-0442-y. Epub 2004 Jan 9.
Gastric tube interposition has become the method of choice for esophageal replacement after esophagectomy. Colon interposition, on the other hand, is widely considered to be a method of last resort, associated with high morbidity and mortality. The present study reviews our experience with colon interposition for esophageal replacement.
Nineteen consecutive patients undergoing colon interposition for esophageal replacement between 1 January 1994 and 31 July 2001 were reviewed. Outcome was compared with international publications on colon interposition as well as with our results following gastric tube interposition (fundus rotation gastroplasty).
Fourteen men and five women with a median age of 68 years (range 44-78) underwent colon interposition for benign ( n=9) and malignant ( n=10) lesions. Eighteen patients underwent trans-hiatal esophagectomy with cervical anastomosis, and one patient underwent thoraco-abdominal esophagectomy with intrathoracic anastomosis. Surgical morbidity was 36.8% (7/19). Anastomotic insufficiency and fatal mediastinal bleeding occurred in one patient each (5.3%). No cases of graft necrosis were observed, and no re-operations were necessary. In-hospital mortality was 15.8% (3/19), twice due to surgical complications (abdominal sepsis, mediastinal bleeding) and once due to pulmonary and cardiac failure. As a late complication, four patients (21.1%) developed anastomotic strictures that necessitated repeated endoscopic dilatation.
Gastric tube interposition remains the method of choice for esophageal replacement. Colon interposition, however, is a valuable alternative with a good long-term function. Early mortality, however, remains a matter of serious concern.
胃管置入已成为食管切除术后食管重建的首选方法。另一方面，结肠代食管术被广泛认为是一种最后的手段，其与高发病率和死亡率相关。本研究回顾了我们采用结肠代食管术进行食管重建的经验。
对1994年1月1日至2001年7月31日期间连续19例行结肠代食管术进行食管重建的患者进行了回顾性研究。将结果与关于结肠代食管术的国际文献以及我们采用胃管置入术（胃底翻转胃成形术）的结果进行了比较。
14例男性和5例女性，中位年龄68岁（范围44 - 78岁），因良性病变（n = 9）和恶性病变（n = 10）接受了结肠代食管术。18例患者行经裂孔食管切除术并颈部吻合，1例患者行胸腹联合食管切除术并胸内吻合。手术并发症发生率为36.8%（7/19）。分别有1例患者发生吻合口漏和致命性纵隔出血（5.3%）。未观察到移植组织坏死病例，也无需再次手术。住院死亡率为15.8%（3/19），其中2例死于手术并发症（腹腔感染、纵隔出血），1例死于肺和心力衰竭。作为晚期并发症，4例患者（21.1%）出现吻合口狭窄，需要反复进行内镜扩张。
胃管置入仍然是食管重建的首选方法。然而，结肠代食管术是一种具有良好长期功能的有价值的替代方法。不过，早期死亡率仍然是一个严重令人担忧的问题。
