Dickinson Karen J, Blackmon Shanda H
Department of Thoracic Surgery, Mayo Clinic, MA-12-00-1, 200 First Street, Rochester, MN 55905, USA.
Department of Thoracic Surgery, Mayo Clinic, MA-12-00-1, 200 First Street, Rochester, MN 55905, USA.
Thorac Surg Clin. 2015 Nov;25(4):461-70. doi: 10.1016/j.thorsurg.2015.07.008. Epub 2015 Sep 9.
The management of conduit necrosis during or after esophagectomy requires the assembly of a multidisciplinary team to manage nutrition, sepsis, intravenous access, reconstruction, and recovery. Reconstruction is most often performed as a staged procedure. The initial surgery is likely to involve esophageal diversion onto the chest where possible, making an effort to preserve esophageal length. Optimization of patients before reconstruction enhances outcomes following reconstruction with either jejunum or colon after gastric conduit failure. Maintaining enteral access for feeding at all times is imperative. Management of patients should be performed at high-volume esophageal centers performing regular reconstructions.
食管切除术中或术后管道坏死的管理需要组建一个多学科团队来管理营养、败血症、静脉通路、重建和恢复。重建通常分阶段进行。初始手术可能会尽可能将食管改道至胸部，努力保留食管长度。在重建前对患者进行优化可提高胃管道失败后使用空肠或结肠重建后的效果。必须始终保持肠内营养通路。患者的管理应在经常进行重建手术的大容量食管中心进行。
