Ni Song, Zhu Yiming, Wang Jian, Li Dezhi, Zhang Bin, Xu Zhengang, Liu Shaoyan
Department of Head and Neck Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China.
ORL J Otorhinolaryngol Relat Spec. 2015;77(5):262-7. doi: 10.1159/000433548. Epub 2015 Aug 29.
To determine the appropriate salvage method after total necrosis of a jejunal graft after reconstruction of total laryngopharyngoesophagectomy or a larynx-preserving operation, considering the complexity of medical service in China.
We reviewed 5 patients with a mean age of 61 years who developed total jejunal graft necrosis and underwent reconstruction of a free jejunal transfer in our hospital. The total number and choice of salvage procedures, the symptoms and the results of salvage for the 5 patients have been reviewed.
Four of the 5 patients survived. One of them underwent gastric pull-up reconstruction and recovered well. One patient died due to severe infection after the loss of the jejunal graft and secondary gastric pull-up reconstruction. A temporary external fistula was formed in 3 patients after the initial jejunal graft necrosis, 2 of which underwent fistula repair 6 and 5 months later, while one went on long-term gastric tube feeding.
Our results suggest that a temporary external fistula formation is an optional secondary salvage procedure after total necrosis of an initial jejunal graft, considering the relatively low quality of medical service in China.
考虑到中国医疗服务的复杂性，确定全喉咽食管切除术重建或保喉手术后空肠移植物完全坏死后的合适挽救方法。
我们回顾了我院5例平均年龄61岁、发生空肠移植物完全坏死并接受游离空肠移植重建的患者。对这5例患者的挽救手术总数及选择、症状和挽救结果进行了回顾。
5例患者中有4例存活。其中1例行胃上提重建，恢复良好。1例患者在空肠移植物丢失及二次胃上提重建后因严重感染死亡。3例患者在初次空肠移植物坏死后形成了临时性外瘘，其中2例分别在6个月和5个月后进行了瘘修补，而1例继续长期经胃管喂养。
我们的结果表明，考虑到中国相对较低的医疗服务质量，临时性外瘘形成是初次空肠移植物完全坏死后一种可供选择的二次挽救手术。
