Schusterman M A, Shestak K, de Vries E J, Swartz W, Jones N, Johnson J, Myers E, Reilly J
Department of Plastic Surgery, University of Pittsburgh, Pa.
Plast Reconstr Surg. 1990 Jan;85(1):16-21. doi: 10.1097/00006534-199001000-00004.
Use of enteric grafts is a popular method for reconstruction of the cervical esophagus and hypopharynx. Free jejunal transfer (FJT) and gastric pull-up (GP) are the most popular methods used. This discussion is a retrospective review of our experience with 50 cases of free jejunal transfer and 15 cases of gastric pull-up. The graft survival rate was 94 percent (47 of 50) for free jejunal transfer and 87 percent (13 of 15) for gastric pull-up. Successful swallowing was achieved in 88 percent (44 of 50) of free jejunal transfers and 87 percent (13 of 15) of gastric pull-ups. Patients with free jejunal transfers were able to swallow and leave the hospital sooner: 10.6 versus 16.0 days and 22.3 versus 29.0 days, respectively. Fistulas occurred in 16 percent (8 of 50) of free jejunal transfers, most of which (6 of 8) healed spontaneously. Fistulas occurred in 20 percent (3 of 15) of gastric pull-ups, only one of which healed spontaneously. Stricture was the most common late complication for free jejunal transfers, 22 percent (11 of 50), whereas reflux was most common in gastric pull-ups, 20 percent (3 of 15). In patients with advanced cancer, extensive esophageal resection into the chest is often required, and gastric pull-up seems to be an easier and more direct form of reconstruction. In limited resection of the hypopharynx and esophagus, especially with proximal lesions, free jejunal transfer is simpler and avoids mediastinal dissection. This concept as well as other advantages and disadvantages of both techniques will be discussed.
使用肠道移植物是重建颈段食管和下咽的一种常用方法。游离空肠移植（FJT）和胃上提术（GP）是最常用的方法。本讨论是对我们50例游离空肠移植和15例胃上提术经验的回顾性分析。游离空肠移植的移植物存活率为94%（50例中的47例），胃上提术为88%（15例中的13例）。88%（50例中的44例）的游离空肠移植和87%（15例中的13例）的胃上提术实现了成功吞咽。接受游离空肠移植的患者能够更快吞咽并出院：分别为10.6天对16.0天以及22.3天对29.0天。游离空肠移植中有16%（50例中的8例）发生瘘管，其中大部分（8例中的6例）自行愈合。胃上提术中有20%（15例中的3例）发生瘘管，仅1例自行愈合。狭窄是游离空肠移植最常见的晚期并发症，为22%（50例中的11例），而反流在胃上提术中最常见，为20%（15例中的3例）。对于晚期癌症患者，通常需要广泛切除食管至胸部，胃上提术似乎是一种更简便、更直接的重建方式。在有限切除下咽和食管时，尤其是近端病变，游离空肠移植更简单且避免纵隔解剖。将讨论这一概念以及两种技术的其他优缺点。
