Oida Takatsugu, Mimatsu Kenji, Kano Hisao, Kawasaki Atsushi, Kuboi Youichi, Fukino Nobutada, Kida Kazutoshi, Amano Sadao
Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Japan.
Hepatogastroenterology. 2012 Sep;59(118):1832-4. doi: 10.5754/hge10213.
BACKGROUND/AIMS: Colon interposition is the most commonly used method of esophageal reconstruction when the stomach cannot be used; however, this method may cause surgical complications such as anastomotic leakage and sepsis due to colon necrosis. Therefore, many surgeons use a retrosternal or subcutaneous route because it is easier to manage the subcutaneous drainage when anastomotic leakage occurs. However, some researchers have reported that the posterior mediastinal route provides better long-term functional outcomes after surgery than the anterior mediastinal route. Thus, in this study, we compared these reconstruction routes used for colon interposition, with or without the supercharge technique, in patients with a history of distal gastrectomy, who have undergone colon interposition after esophagectomy.
We retrospectively studied 30 patients who underwent esophagectomy with colon interposition. These patients were divided into 2 groups based on the reconstruction route: the anterior mediastinal or subcutaneous route (A group), or the posterior mediastinal route (R group).
Anastomotic leakages were observed in 4 patients (26.7%) in the A group and in 1 patient (6.7%) in the R group.
Ischemia is not always the result of arterial failure, but may also originate from venous blood flow impairment due to injury or distortion of veins.
背景/目的：当无法使用胃进行食管重建时，结肠代食管是最常用的方法；然而，这种方法可能会导致手术并发症，如吻合口漏和因结肠坏死引起的脓毒症。因此，许多外科医生采用胸骨后或皮下路径，因为发生吻合口漏时更容易处理皮下引流。然而，一些研究人员报告说，与前纵隔路径相比，后纵隔路径在手术后能提供更好的长期功能结果。因此，在本研究中，我们比较了在远端胃切除术后接受食管切除术后结肠代食管的患者中，采用或不采用增压技术的这些重建路径。
我们回顾性研究了30例行食管切除并结肠代食管的患者。根据重建路径将这些患者分为2组：前纵隔或皮下路径组（A组），或后纵隔路径组（R组）。
A组有4例患者（26.7%）发生吻合口漏，R组有1例患者（6.7%）发生吻合口漏。
缺血并不总是动脉供血不足的结果，也可能源于静脉损伤或扭曲导致的静脉血流受损。
