Tabira Y, Sakaguchi T, Teshima K, Kuhara H, Kawasuji M
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Dis Esophagus. 2004;17(2):172-5. doi: 10.1111/j.1442-2050.2004.00397.x.
We experienced three patients with persistent outlet obstruction after free jejunal graft and performed T-shaped re-anastomosis for relief of this symptom. Two patients underwent a laryngopharyngectomy for hypopharyngeal cancer and the other patient underwent a laryngopharyngectomy and total esophagectomy for concurrent hypopharyngeal cancer and esophageal cancer. We reconstructed alimentary conduit by a free jejunal reconstruction without using surgical microscopes. In brief, a graft vein and the internal jugular vein were anastomosed and a graft artery and the carotid artery were anastomosed. Then, the anastomosis of pharyngojejunostomy was carried out in a side-to- end fashion, followed by an end-to- end jejunesophagostomy. In a T-shaped re-anastomosis, the flexure of the transplanted jejunum was separated by GIA (US Surgical Corporation, Norwalk, CT, USA). In cases where the efferent part was redundant, the proximal or distal site was resected and straightened in order to avoid outlet stasis. After this, the end-to-side anastomosis between the efferent part and the bottom of proximal horizontal portion of the graft was performed by CDH (Ethicon, Somerville, NJ, USA) or Olsen's one layer method. These three patients received this operation and were relieved from persistent dysphagia. This method is a safe and easy procedure for relief from dysphagia and for recovery of quality of life for patients with this complication. However, it is of utmost importance to perform a reconstruction followed by profluent passage at the first operation.
我们遇到了3例游离空肠移植术后持续性出口梗阻的患者，并进行了T形再吻合术以缓解此症状。2例患者因下咽癌接受了喉咽切除术，另1例患者因同时患有下咽癌和食管癌接受了喉咽切除术及全食管切除术。我们在不使用手术显微镜的情况下通过游离空肠重建术重建消化道。简而言之，将移植静脉与颈内静脉吻合，将移植动脉与颈动脉吻合。然后，以端侧方式进行咽空肠吻合，接着进行空肠食管端端吻合。在T形再吻合术中，用GIA（美国外科公司，美国康涅狄格州诺沃克）分离移植空肠的弯曲部。在传出部冗余的情况下，切除近端或远端部位并使其变直，以避免出口淤滞。在此之后，用CDH（美国强生公司，美国新泽西州萨默维尔）或奥尔森单层法进行传出部与移植近端水平部底部之间的端侧吻合。这3例患者接受了此手术，持续性吞咽困难得到缓解。该方法对于缓解吞咽困难以及改善有此并发症患者的生活质量而言是一种安全且简便的手术。然而，在首次手术时进行重建并确保通畅通过至关重要。
