Department of Thoracic Surgery, Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Ann Thorac Surg. 2012 Jun;93(6):1850-4. doi: 10.1016/j.athoracsur.2012.01.068. Epub 2012 Mar 20.
Pharyngo-esophageal reconstruction using free jejunal grafts (FJGs) has been widely used, but the procedure is technically demanding and requires the involvement of multiple departments. We performed simplified reconstruction with FJGs using end-to-side vascular anastomosis and extended pharyngo-jejunostomy.
The jejunal artery and vein were anastomosed to the neck vessels in an end-to-side fashion without microvascular anastomosis. Pharyngo-jejunostomy with extended end-to-end anastomosis was performed to reduce size mismatch. We retrospectively analyzed the medical records of 32 patients diagnosed with pharyngeal, esophageal, or pyriform sinus cancer who received a FJG.
The mean age was 61.5±9.4 years, and there were 25 male patients. Jejunal vessels were commonly anastomosed to the right common carotid artery and the right internal jugular vein (22, 68.8%). The mean ischemic times of the FJG and carotid artery clamping time were 46.5±8.1 and 15.8±4.4 minutes, respectively. During the procedure, 3 patients suffered from inadequate reperfusion of the FJG requiring removal of the initial graft and replacement with another FJG. There were no neurologic complications, postoperative deaths, or adverse events directly related to FJG except for leakage of the pharyngo-jejunostomy site in 1 patient, which was primarily repaired. During the follow-up period, 5 patients (15.6%) suffered from dysphagia, but only 3 patients had evidence of anastomotic strictures at the jejuno-esophagostomy site. Thirteen patients (40.6%) received postoperative adjuvant radiotherapy.
Our technique of FJG with end-to-side vascular anastomosis and extended pharyngo-jejunostomy is simple and safe.
游离空肠移植（FJGs）用于咽食管重建已被广泛应用，但该手术技术要求高，需要多学科参与。我们采用 FJG 进行简化的端侧血管吻合和延伸咽-空肠吻合术。
采用端侧吻合而无需微血管吻合的方式将空肠动静脉与颈部血管吻合。采用延伸端对端吻合术进行咽-空肠吻合术，以减少大小不匹配。我们回顾性分析了 32 例诊断为咽、食管或梨状窝癌患者的病历资料，这些患者均接受了 FJG 治疗。
患者平均年龄为 61.5±9.4 岁，其中 25 例为男性。空肠血管通常与右颈总动脉和右颈内静脉吻合（22 例，68.8%）。空肠移植物和颈动脉夹闭的平均缺血时间分别为 46.5±8.1 和 15.8±4.4 分钟。在手术过程中，3 例患者因 FJG 灌注不足而需要切除初始移植物并用另一个 FJG 替换。除 1 例患者出现咽-空肠吻合口漏需行初次修补外，无其他与 FJG 相关的神经并发症、术后死亡或不良事件。在随访期间，5 例患者（15.6%）出现吞咽困难，但仅 3 例患者在空肠-食管吻合口处出现吻合口狭窄的证据。13 例患者（40.6%）接受了术后辅助放疗。
我们采用的 FJG 端侧血管吻合和延伸咽-空肠吻合术简单、安全。
