Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India.
Ann Surg. 2011 Jul;254(1):62-6. doi: 10.1097/SLA.0b013e3182125ce7.
To analyze the short- and long-term outcomes following surgical treatment for corrosive stricture of the esophagus.
Surgery is a well-established treatment for corrosive strictures of the esophagus and involves either resection or bypass of the damaged esophagus and replacement by a conduit. The need for resection and the choice of the ideal conduit for esophageal replacement in these patients continues to be debated and there are only a few studies reporting on the long-term outcome following the surgical treatment.
This was a retrospective analysis of patients with corrosive stricture of the esophagus who were managed surgically between 1983 and 2009. The type of surgery performed (resection or bypass), the conduit used, the short- and long-term outcomes were assessed.
One hundred seventy-six corrosive strictures of the esophagus were managed surgically (resection: 64, bypass: 112). A transhiatal resection could be accomplished in 59 of 62 patients in whom it was attempted. Stomach conduits were used in 107 patients and colonic conduits in 69. The mean operating time was 4.3 ± 1.5 hours and the mean estimated blood loss 592 ± 386 mL. Cervical anastomotic leak occurred in 22 patients (12.5%). Follow up of more than 10 years was available for 78 patients (44.3%) and more than 15 years for 54 patients (30.7%). Recurrent dysphagia developed in 33 patients (18.7%). There were no differences in the short- or long-term outcomes in patients who underwent resection or bypass. The mean duration of surgery, intraoperative blood loss, incidence of conduit necrosis, and in-hospital mortality was significantly lower in patients with stomach conduits as compared with colonic conduits. There was a higher incidence of recurrent laryngeal nerve palsy, recurrent dysphagia, and aspiration after surgery in patients with strictures involving the upper end of the esophagus at or near the hypopharynx.
Satisfactory outcomes are achieved after surgery for corrosive strictures of the esophagus. Resection of scarred esophagus may be done without a substantial increase in the morbidity and mortality; however, the outcomes are not significantly different from bypass. Stomach is a good conduit and the colon should be reserved for cases where the stomach is not available. Long-term outcomes in patients with hypopharyngeal strictures, however, continue to be poor.
分析腐蚀性食管狭窄患者接受手术治疗后的短期和长期结果。
手术是治疗腐蚀性食管狭窄的一种成熟方法，包括切除或旁路受损食管并用导管替代。对于这些患者，是否需要切除以及选择哪种理想的导管进行食管替代仍存在争议，只有少数研究报告了手术治疗后的长期结果。
这是一项对 1983 年至 2009 年间接受手术治疗的腐蚀性食管狭窄患者的回顾性分析。评估手术类型（切除或旁路）、使用的导管、短期和长期结果。
176 例腐蚀性食管狭窄患者接受了手术治疗（切除：64 例，旁路：112 例）。在尝试进行经食管裂孔切除术的 62 例患者中，有 59 例成功完成。107 例患者使用胃导管，69 例患者使用结肠导管。平均手术时间为 4.3±1.5 小时，平均估计失血量为 592±386ml。22 例（12.5%）患者出现颈部吻合口漏。176 例患者中，78 例（44.3%）获得了超过 10 年的随访，54 例（30.7%）获得了超过 15 年的随访。33 例（18.7%）患者出现复发性吞咽困难。切除或旁路患者的短期和长期结果无差异。与结肠导管相比，胃导管的手术时间、术中出血量、导管坏死发生率和住院死亡率均显著降低。食管上段或近咽下部狭窄的患者术后发生喉返神经麻痹、复发性吞咽困难和吸入的发生率较高。
腐蚀性食管狭窄患者手术后可获得满意的结果。切除瘢痕食管可能不会显著增加发病率和死亡率；然而，结果与旁路并无显著差异。胃是一种良好的导管，只有在胃不可用时才应选择结肠。然而，咽下部狭窄患者的长期结果仍较差。
