Fisher S R, Cameron R, Hoyt D J, Cole T B, Seigler H F, Meyers W C
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Head Neck. 1990 Mar-Apr;12(2):126-30. doi: 10.1002/hed.2880120206.
Forty-seven patients underwent pharyngoesophageal reconstruction using a free jejunal interposition graft (FJIG) at Duke University Medical Center from 1978 through 1987. There were 30 men and 17 women with ages ranging from 38 to 87 years old (mean age, 64 years). Twenty-one patients (group A) had no prior surgical procedures, 20 (group B) were reconstructed following radiation and/or surgical failure, with 6 patients (group C) having benign strictures of the upper alimentary tract. Follow-up ranged up to 122 months (mean, 23 months), with 3 patients lost to follow-up, and 4 perioperative deaths (within 3 months of surgery). There were a total of 9 initial graft failures, 4 patients undergoing successful re-implantation, resulting in an overall success rate of 89% (42 of 47). Excluding patients with graft failures, perioperative deaths, and patients lost to follow-up, 33 of 36 patients with a viable FJIG were able to maintain adequate swallowing function yielding a physiologic success rate of 86%. All of the 21 patients dying of recurrent disease had excellent palliation with the FJIG. Of the 7 patients who are alive, only 1 has dysphagia secondary to stricture. In conclusion, it is felt that the FJIG is a sophisticated method of reconstructing large surgical defects of the pharyngoesophagus with a high technical and physiologic success rate.
1978年至1987年期间，47例患者在杜克大学医学中心接受了游离空肠移植术（FJIG）进行咽食管重建。其中男性30例，女性17例，年龄在38岁至87岁之间（平均年龄64岁）。21例患者（A组）此前未接受过手术，20例（B组）在放疗和/或手术失败后进行了重建，6例患者（C组）患有上消化道良性狭窄。随访时间长达122个月（平均23个月），3例患者失访，4例围手术期死亡（术后3个月内）。共有9例初次移植失败，4例患者成功再次植入，总体成功率为89%（47例中的42例）。排除移植失败、围手术期死亡和失访患者后，36例存活FJIG患者中有33例能够维持足够的吞咽功能，生理成功率为86%。所有21例死于复发性疾病的患者使用FJIG均获得了良好的姑息治疗效果。在7例存活患者中，只有1例因狭窄继发吞咽困难。总之，游离空肠移植术是一种复杂的重建咽食管大手术缺损的方法，技术成功率和生理成功率都很高。
