Dionigi Gianlorenzo, Dionigi Renzo, Rovera Francesca, Boni Luigi, Carcano Giulio
Department of Surgical Sciences, University of Insubria, Varese, Italy.
Int Semin Surg Oncol. 2006 Apr 26;3:10. doi: 10.1186/1477-7800-3-10.
Bowel reconstruction after subtotal esophagectomy represents a problem when a previous distal gastrectomy was performed: usually the colon or jejunum is used.
In a 10 year period 126 patients with primary esophageal cancer underwent esophageal resection in our Department. Surgical procedures were 57% two-phase subtotal oesophagectomy, 23% transhiatal, 9% stripping, 10 three-phase total esophagectomy and 2 endoscopic resections.
In 112 patients alimentary tract reconstruction was achieved by means of esophago-gastric anastomosis. Reconstruction was performed using colon in 10 cases and jejunum in 2. We describe the technical aspects of esophagectomy and gastric reconstruction in a patient with previous antrectomy and Billroth II reconstruction. The procedure was performed via a combined laparotomy and thoracotomy with anastomosis at the level of the azygous vein using the remnant stomach.
Few technical reports have been reported in literature about the use of remnant stomach in reconstruction for subtotal esophagectomy subsequent to distal gastrectomy. Several hypotheses are made to explain the maintenance of the gastric vascular integrity as its intramural network without micro-vascular anastomosis.
当先前已进行远端胃切除时，食管次全切除术后的肠道重建是一个难题：通常使用结肠或空肠。
在10年期间，我们科室有126例原发性食管癌患者接受了食管切除术。手术方式包括57%的两阶段食管次全切除术、23%的经裂孔食管切除术、9%的剥脱术、10例三阶段全食管切除术以及2例内镜切除术。
112例患者通过食管胃吻合术实现了消化道重建。10例使用结肠重建，2例使用空肠重建。我们描述了1例先前接受过胃窦切除术和毕罗Ⅱ式重建的患者的食管切除术及胃重建的技术要点。该手术通过剖腹术和开胸术联合进行，利用残余胃在奇静脉水平进行吻合。
关于远端胃切除术后残余胃用于食管次全切除重建的技术报道在文献中较少。人们提出了几种假设来解释在没有微血管吻合的情况下，胃壁内网络如何维持胃血管的完整性。
