Takeno Shinsuke, Takahashi Yoshiaki, Moroga Toshihiko, Yamamoto Satoshi, Kawahara Katsunobu, Hirano Takashi, Maeda Kazuhiko, Suzuki Masashi, Yamashita Yuichi
Hepatogastroenterology. 2013 Nov-Dec;60(128):1966-71.
BACKGROUND/AIMS: Reconstruction using a free jejunal graft (FJG) after resection of the cervical esophagus has become common, but postoperative morbidity remains. We report herein our procedure and the results of reconstruction for neck cancer using FJGs.
Twenty-four patients underwent FJG reconstruction after laryngo-pharyngo-esophagectomy. We perform a mini-laparotomy with a 5-cm para- or trans-rectus muscle incision. The FJG is then harvested from the jejunum supplied by the second or third mesenteric artery, and a jejunostomy is created. Pharyngo-jejunal anastomosis is performed using an Albert-Lembert suture and jejunal-esophageal anastomosis by a circular stapling technique. The facial artery or suprathyroid artery is used as the feeding artery, and the common facial vein or external jugular vein as the drainage vein. Vascular anastomosis is performed microsurgically.
In terms of postoperative morbidity, minor anastomosis leakage of the pharyngo-jejunal anastomosis was observed in one patient, stricture of the jejunal-esophageal anastomosis in four, and wound infection in one. No cases of passage disorder due to graft bending were seen, and no patients died.
The procedure using FJG harvested via mini-laparotomy is minimally invasive and is a feasible procedure for reconstruction after laryngo-pharyngo-esophagectomy, resulting in low morbidity.
背景/目的：颈段食管切除术后采用游离空肠移植（FJG）进行重建已较为常见，但术后仍存在并发症。本文报告我们使用FJG进行颈部癌症重建的手术方法及结果。
24例患者在喉咽食管切除术后接受了FJG重建。我们采用5厘米旁正中或经腹直肌切口进行迷你剖腹术。然后从由肠系膜第二或第三动脉供血的空肠获取FJG，并进行空肠造口术。采用阿尔贝-伦贝特缝合法进行咽空肠吻合，通过圆形吻合器技术进行空肠食管吻合。使用面动脉或甲状腺上动脉作为供血动脉，面总静脉或颈外静脉作为引流静脉。采用显微外科技术进行血管吻合。
在术后并发症方面，1例患者出现咽空肠吻合口轻微吻合口漏，4例出现空肠食管吻合口狭窄，1例出现伤口感染。未观察到因移植肠管弯曲导致的通道障碍病例，也无患者死亡。
通过迷你剖腹术获取FJG的手术具有微创性，是喉咽食管切除术后重建的可行方法，并发症发生率低。
