Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Université Paris 7 Diderot, Paris, France.
Ann Thorac Surg. 2012 Mar;93(3):905-12. doi: 10.1016/j.athoracsur.2011.12.054.
The main purpose of the study was to report a comparative experience with primary and secondary esophagocoloplasty for caustic injuries. Secondary esophagocoloplasty is the main rescue option after graft loss, but data in the literature are scarce.
The operative characteristics, postoperative course, and functional outcomes of 21 secondary and of 246 primary esophagocoloplasty operations performed for caustic injuries between 1987 and 2006 were compared. Intraoperative events requiring significant changes in the planned operative strategy, such as graft ischemia or necrosis, were recorded. Statistical tests were performed in both cohorts to identify factors predictive of postoperative graft necrosis. Univariate analysis was performed to identify factors predictive of functional failure after secondary esophagocoloplasty.
Operative mortality (5% vs 4%, p=0.56), morbidity (62% vs 59%, p=0.96), postoperative graft necrosis (14% vs 7%, p=0.16), and functional success (68% vs 70%, p=0.79) rates of the secondary and primary esophagocoloplasty operations were similar. Intraoperative graft ischemia at the time of secondary esophagocoloplasty was significantly associated with the risk of postoperative graft necrosis (p=0.015) and functional failure (p=0.046). At the time of primary esophagocoloplasty, intraoperative necrosis of the colon was the only independent predictive factor of postoperative graft necrosis (p<0.0001).
Secondary esophagocoloplasty is a safe and reliable salvage option after primary graft loss in patients with caustic injuries. Delayed esophagocoloplasty should be considered if intraoperative colon necrosis occurs at the time of primary reconstruction.
本研究的主要目的是报告腐蚀性损伤一期和二期食管结肠重建的对比经验。二期食管结肠重建是移植物丢失后的主要抢救选择，但文献中的数据很少。
比较了 1987 年至 2006 年间因腐蚀性损伤而行的 21 例二期和 246 例一期食管结肠重建手术的手术特点、术后过程和功能结果。记录了需要对计划手术策略进行重大更改的术中事件，如移植物缺血或坏死。对两个队列进行了统计检验，以确定预测术后移植物坏死的因素。对二期食管结肠重建后功能失败的预测因素进行了单变量分析。
手术死亡率（5%比 4%，p=0.56）、发病率（62%比 59%，p=0.96）、术后移植物坏死（14%比 7%，p=0.16）和功能成功率（68%比 70%，p=0.79）二期和一期食管结肠重建手术相似。二期食管结肠重建时移植物缺血与术后移植物坏死（p=0.015）和功能失败（p=0.046）的风险显著相关。在一期食管结肠重建时，术中结肠坏死是术后移植物坏死的唯一独立预测因素（p<0.0001）。
在腐蚀性损伤患者中，一期移植物丢失后，二期食管结肠重建是一种安全可靠的抢救选择。如果在一期重建时发生术中结肠坏死，应考虑延迟行食管结肠重建。
