Okazaki Mutsumi, Asato Hirotaka, Okochi Masayuki, Suga Hirotaka
Department of Plastic and Reconstructive Surgery, Kyorin University, Tokyo.
J Reconstr Microsurg. 2007 May;23(4):213-8. doi: 10.1055/s-2007-981503.
The reported success rates of free jejunal transfer are over 95%, but in cases of postoperative vascular thrombosis, the salvage of jejunal flap is often difficult because of poor ischemic tolerance of the jejunum. To reduce the incidence of jejunal necrosis due to vascular thrombosis to nearly zero, we employed one-segment double vascular pedicled free jejunal transfer. Different from conventional double pedicled free jejunal transfer (transfer of the two jejunal segments by anastomosing two pairs of jejunal root vessels), the arcade vessels are used as an additional feeder after the routine anastomosis of jejunal root vessels in our method. Between December 2004 and January 2006, 20 patients with laryngeal, pharyngeal, or cervical esophageal cancer underwent free jejunal transfer using this method. In all patients, the jejunal flap survived completely without any complication associated with vascular anastomosis or blood circulation of the flap. The disadvantage of this procedure is the approximately 1-hour prolonged operative time. Although we have experienced only 20 cases and not obtained statistically significant validity of this method compared with conventional one, we believe that the concept of our method is one of the help for safer pharyngoesophageal reconstruction, especially in patients with higher risk of vascular thrombosis.
游离空肠移植术报道的成功率超过95%，但在术后血管血栓形成的病例中，由于空肠对缺血的耐受性较差，空肠瓣的挽救往往很困难。为了将血管血栓形成导致的空肠坏死发生率降至几乎为零，我们采用了单段双血管蒂游离空肠移植术。与传统的双蒂游离空肠移植术（通过吻合两对空肠根部血管来移植两段空肠）不同，在我们的方法中，空肠根部血管常规吻合后，弓状血管用作额外的供血血管。2004年12月至2006年1月期间，20例喉癌、下咽癌或颈段食管癌患者采用该方法进行了游离空肠移植。所有患者的空肠瓣均完全存活，未出现与血管吻合或皮瓣血液循环相关的任何并发症。该手术的缺点是手术时间延长约1小时。尽管我们仅经历了20例病例，与传统方法相比尚未获得该方法具有统计学意义的有效性，但我们认为我们方法的理念有助于更安全地进行下咽食管重建，特别是对于血管血栓形成风险较高的患者。
