Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
J Gastrointest Surg. 2013 Aug;17(8):1507-11. doi: 10.1007/s11605-013-2176-7. Epub 2013 Mar 5.
In gastric tube reconstruction, anastomotic leakage and stricture occasionally occur. Additionally, new or recurrent cancer may occur in the esophageal remnant or at the anastomotic site. Such complications, after cervical anastomoses, led to our adoption of a procedure to approach the anastomosis by manubrium and proximal left clavicle resection. This procedure was applied to seven patients between April 2000 and March 2011. The mean age of the patients was 69.9 years (range, 65-76 years); all were men. The mean operative time was 506 min (range, 374-845 min), with an average blood loss of 297 ml (range, 180-606 ml). Esophagogastric anastomoses were performed in two cases, and free jejunal graft transplantations were performed in the remaining five cases; oral intake became possible for all patients. Limited range of motion or other movement disorders of the neck and upper limbs, due to the upper sternum and clavicle resection, were not observed. This invasive surgical procedure can be acceptable for patients who are facing life-threatening consequences or significant decreases in quality of life and are resistant to conservative treatment.
在胃管重建中，吻合口瘘和狭窄偶尔会发生。此外，食管残端或吻合部位可能会出现新的或复发性癌症。这些并发症发生在颈部吻合后，促使我们采用了一种通过胸骨柄和左锁骨近端切除来接近吻合口的手术。该手术于 2000 年 4 月至 2011 年 3 月期间应用于 7 例患者。患者的平均年龄为 69.9 岁（范围为 65-76 岁）；均为男性。平均手术时间为 506 分钟（范围为 374-845 分钟），平均出血量为 297 毫升（范围为 180-606 毫升）。有两例进行了食管胃吻合术，其余五例进行了游离空肠移植术；所有患者均可以经口摄入。由于胸骨柄和锁骨近端切除，未观察到颈部和上肢活动受限或其他运动障碍。对于那些面临危及生命的后果或生活质量显著下降且对保守治疗有抵抗力的患者来说，这种侵袭性手术是可以接受的。
