Chirica M, de Chaisemartin C, Munoz-Bongrand N, Halimi B, Celerier M, Cattan P, Sarfati E
Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
J Chir (Paris). 2009 Jun;146(3):240-9. doi: 10.1016/j.jchir.2009.06.008. Epub 2009 Jul 28.
Retrosternal coloplasty is the gold standard for esophageal reconstruction after caustic injury of the digestive tract. Complete preoperative otolaryngology evaluation and the control of the psychiatric disease are key factors for success. In the absence of controlled studies, the choice between the right and the left colon graft relies on the anatomy of the blood supply to the colon and on the individual surgeon's preference. Treatment of associated pharyngeal and laryngeal injuries is mandatory at the time of esophageal reconstruction. In experienced hands mortality rates are less than 5% but specific postoperative complications (graft necrosis, leakage, anastomotic stricture) are high. The low risk of cancer development in the by-passed esophagus does not justify routine esophagectomy at the time of reconstruction. Sixty to eighty percent of patients would finally retrieve nutritional autonomy after coloplasty for caustic injury. Late acquired dysfunctions of the coloplasty (anastomotic strictures, graft redundancy) requiring revision surgery occur frequently and might jeopardize an already fragile functional result. Timely diagnosis and treatment of such complications and the necessity of continuous psychological surveillance justify the need for long term follow up in these patients.
胸骨后结肠成形术是消化道腐蚀性损伤后食管重建的金标准。术前全面的耳鼻喉科评估和精神疾病的控制是成功的关键因素。在缺乏对照研究的情况下，右半结肠移植和左半结肠移植的选择取决于结肠血供的解剖结构以及外科医生的个人偏好。在食管重建时，必须同时治疗相关的咽喉部损伤。在经验丰富的医生手中，死亡率低于5%，但特定的术后并发症（移植物坏死、渗漏、吻合口狭窄）发生率较高。旁路食管发生癌症的风险较低，因此在重建时进行常规食管切除术并不合理。60%至80%的患者在因腐蚀性损伤接受结肠成形术后最终能够恢复营养自主。结肠成形术后期出现的需要翻修手术的功能障碍（吻合口狭窄、移植物冗余）很常见，可能会危及本就脆弱的功能结果。及时诊断和治疗此类并发症以及持续进行心理监测的必要性证明了对这些患者进行长期随访的必要性。
