Ninomiya Itasu, Okamoto Kouichi, Oyama Katsunobu, Hayashi Hironori, Miyashita Tomoharu, Tajima Hidehiro, Kitagawa Hirohisa, Fushida Sachio, Fujimura Takashi, Ohta Tetsuo
Gastroenterologic Surgery, Department of Oncology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan,
Gen Thorac Cardiovasc Surg. 2014 Oct;62(10):627-34. doi: 10.1007/s11748-014-0435-5. Epub 2014 Jun 12.
An alternative conduit is needed when the gastric tube cannot be used as an esophageal substitute for reconstruction after esophagectomy. We adopted pedicle jejunal reconstruction with intrathoracic anastomosis in the upper mediastinum under such circumstances. The aim of this study was to evaluate the feasibility of this technique.
Two hundred and ten patients with esophageal cancer underwent esophagectomy and reconstruction from 1998 to 2013. Among them, 6 patients underwent colon interposition (colon group) and 13 underwent jejunum reconstruction (jejunum group) including 8 thoracoscopic anastomosis. The operative results of both groups were compared with those of 191 gastric tube reconstructions (stomach group).
The operative times in the colon and jejunum groups were significantly longer than that in the stomach group (P = 0.001 and P = 0.018, respectively). The colon group showed more operative blood loss and more frequent anastomotic leakage and ischemic stenosis of the conduit than did the stomach group (1605 vs. 530 g, P = 0.007; 50 vs. 12.6 %, P = 0.035; 16.7 vs. 0 %, P = 0.03, respectively). There was no anastomotic leakage, conduit necrosis and mortality in the jejunum group. Ischemic stenosis of the conduit occurred more frequently in jejunum group than in the stomach group (23.1 vs. 0 %, P < 0.001). However, the stenosis could be managed safely with endoscopic treatment. Patient survival in the colon and jejunum groups was consistent with that in the stomach group.
Pedicle jejunal reconstruction with intrathoracic anastomosis can be performed safely under thoracotomy or thoracoscopic surgery when stomach cannot be used as an esophageal substitute after esophagectomy.
当胃管不能用作食管切除术后重建的食管替代物时，需要一种替代管道。在这种情况下，我们采用了在上纵隔进行胸内吻合的带蒂空肠重建术。本研究的目的是评估该技术的可行性。
1998年至2013年期间，210例食管癌患者接受了食管切除和重建手术。其中，6例患者接受了结肠间置术（结肠组），13例接受了空肠重建术（空肠组），包括8例胸腔镜吻合术。将两组的手术结果与191例胃管重建术（胃组）的结果进行比较。
结肠组和空肠组的手术时间明显长于胃组（分别为P = 0.001和P = 0.018）。结肠组的手术失血量更多，管道吻合口漏和缺血性狭窄的发生率比胃组更高（分别为1605 vs. 530 g，P = 0.007；50% vs. 12.6%，P = 0.035；16.7% vs. 0%，P = 0.03）。空肠组没有吻合口漏、管道坏死和死亡病例。空肠组管道缺血性狭窄的发生率比胃组更高（23.1% vs. 0%，P < 0.001）。然而，这种狭窄可以通过内镜治疗安全处理。结肠组和空肠组患者的生存率与胃组一致。
当食管切除术后胃不能用作食管替代物时，在开胸手术或胸腔镜手术下，采用胸内吻合的带蒂空肠重建术可以安全进行。
