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腐蚀性食管狭窄行食管重建的咽结肠吻合术

Pharyngocolonic anastomosis for esophageal reconstruction in corrosive esophageal stricture.

作者信息

Jiang Yao-Guang, Lin Yi-Dan, Wang Ru-Wen, Zhou Jing-Hai, Gong Tai-Qian, Ma Zheng, Zhao Yun-Ping, Tan Qun-You

机构信息

Thoracic Surgery Department, Daping Hospital, Chongqing, China.

出版信息

Ann Thorac Surg. 2005 Jun;79(6):1890-4. doi: 10.1016/j.athoracsur.2004.12.046.

Abstract

BACKGROUND

The aim of our study is to observe the outcome of pharyngocolonic anastomosis in esophageal reconstruction for diffuse corrosive esophageal stricture involving hypopharynx.

METHODS

This is a retrospective report of the experience and results of 14 patients undergoing esophageal reconstruction with pharyngocolonic anastomosis without resection of the strictured intrathoracic esophagus. The left colonic segment was pulled up to the neck through the substernal space in all patients.

RESULTS

There was no operative or hospital death. Postoperative complications included cervical anastomotic leakage in 4 patients, rupture of abdominal incision in 1 patient, and aspiration pneumonia in 2 patients. The length of follow-up ranged from half a year to 10 years, with an average of 4 years. Anastomotic stenosis occurred in 2 patients. One patient was improved after dilatation and the other was relieved by plastic operation. One patient began to have vomiting after meals 7 months after surgery and was found to have redundant abdominal colon graft, which was corrected with a side-to-side anastomosis between the colon and the stomach.

CONCLUSIONS

A successful reconstruction for hypopharyngoesophageal stricture requires a sufficiently large hypopharyngocolonic anastomosis and a technique of good anastomosis. From our experience, this procedure is shown to be safe and effective.

摘要

背景

我们研究的目的是观察下咽结肠吻合术在涉及下咽的弥漫性腐蚀性食管狭窄的食管重建中的效果。

方法

这是一项对14例接受下咽结肠吻合术且未切除胸段狭窄食管的食管重建患者的经验和结果的回顾性报告。所有患者均通过胸骨后间隙将左结肠段上提至颈部。

结果

无手术死亡或住院死亡。术后并发症包括4例颈部吻合口漏、1例腹部切口裂开和2例吸入性肺炎。随访时间为半年至10年,平均4年。2例发生吻合口狭窄。1例经扩张后改善,另1例经整形手术缓解。1例患者术后7个月开始出现餐后呕吐,发现腹部结肠移植冗长,通过结肠与胃的侧侧吻合进行了纠正。

结论

下咽食管狭窄的成功重建需要足够大的下咽结肠吻合口和良好的吻合技术。根据我们的经验,该手术显示是安全有效的。

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