Zhou Jing-Hai, Jiang Yao-Guang, Wang Ru-Wen, Lin Yi-Dan, Gong Tai-Qian, Zhao Yun-Ping, Ma Zheng, Tan Qun-You
Department of Thoracic Surgery, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China.
J Thorac Cardiovasc Surg. 2005 Aug;130(2):449-55. doi: 10.1016/j.jtcvs.2005.02.029.
We sought to present our experience in the management of esophageal burns.
From April 1976 through October 2003, 149 patients with corrosive esophageal burns were included in this study. Treatment modalities consisted of modified intraluminal stenting in 28, colon interposition in 71, gastric transposition in 25, repair of cervical stricture with platysma myocutaneous flap in 17, and miscellaneous operations in 12 patients. Eleven of these patients underwent the above procedures twice at our institute. The remaining 7 patients were treated with conservative therapy.
Twenty-three patients recovered from intraluminal stenting, and 5 experienced stricture after stent removal. One of the 5 patients with failed stents responded to bougienage, and the remaining 4 patients required esophageal reconstruction later. Of the 71 colon interpositions, 5 patients died postoperatively, and complications consisted of proximal anastomotic fistula in 17, anastomotic stenosis in 6, and abdominal incision dehiscence in 2 patients. Postoperative complications in the 25 patients with gastric transpositions comprised anastomotic stricture in 2 patients and empyema in 1 patient. There was a cervical leak in 1 of the 17 patients undergoing the repair of cervical esophageal or anastomotic stricture with a platysma myocutaneous flap. One of the patients in the group undergoing 12 miscellaneous procedures died 8 months after surgical intervention. All the survivors currently eat regular diets.
Intraluminal stenting can prevent the formation of caustic esophageal stricture. The location of the cicatricial esophagus dictates whether to perform concomitant esophagectomy during esophageal reconstruction. Platysma myocutaneous flap repair is an excellent method for the treatment of severe cervical esophageal or anastomotic stricture.
我们试图展示我们在食管烧伤治疗方面的经验。
从1976年4月至2003年10月，本研究纳入了149例腐蚀性食管烧伤患者。治疗方式包括改良腔内支架置入术28例、结肠代食管术71例、胃转位术25例、采用颈阔肌肌皮瓣修复颈部狭窄17例以及12例患者接受其他各类手术。其中11例患者在我们研究所接受了上述手术两次。其余7例患者接受保守治疗。
23例患者腔内支架置入术后恢复，5例在支架取出后出现狭窄。5例支架置入失败的患者中，1例对探条扩张治疗有反应，其余4例患者后来需要进行食管重建。71例结肠代食管术中，5例患者术后死亡，并发症包括17例近端吻合口瘘、6例吻合口狭窄和2例腹部切口裂开。25例胃转位术患者的术后并发症包括2例吻合口狭窄和1例脓胸。17例采用颈阔肌肌皮瓣修复颈部食管或吻合口狭窄的患者中有1例出现颈部渗漏。12例接受其他各类手术的患者中有1例在手术干预8个月后死亡。所有幸存者目前均能正常饮食。
腔内支架置入可预防腐蚀性食管狭窄的形成。瘢痕食管的位置决定了在食管重建过程中是否同时进行食管切除术。颈阔肌肌皮瓣修复是治疗严重颈部食管或吻合口狭窄的一种极佳方法。
