Banerjee J K, Saranga Bharathi R
Dis Esophagus. 2017 Apr 1;30(4):1-11. doi: 10.1093/dote/dow030.
Corrosive upper aerodigestive tract strictures are conventionally treated by open surgery. Surgical advancements permit these strictures to be addressed with minimal invasion. Corrosive strictures treated minimally invasively over a 2-year period (2014-2015) were audited. Colonic mobilization and retrosternal tunneling were performed laparoscopically. The left colic vessel-based isoperistaltic colonic/ileocolonic segment was transposed substernally into the neck, aided by miniceliotomy. Proximal anastomosis was side-to-side esophagocolic in all patients except those who underwent pharyngolaryngectomy or partial laryngectomy, where pharyngocolic/pyriform fossa-ileal anastomosis was employed. Distal anastomoses were colo-jejunal and colocolic/ileocolic in all the patients. Enteral nutrition and ambulation were commenced on the first postoperative day. Oral nutrition was commenced following a normal contrast swallow on the seventh postoperative day. Patients were followed up on an outpatient basis. Ten adults, aged between 19 and 40 years, were treated for acid-induced strictures. Esophagus and stomach were multiply strictured in all patients. Additionally, duodenum was involved in two patients while pharynx and larynx were strictured in three patients. Two patients underwent pharyngolaryngectomy. One patient underwent partial laryngectomy. The average operative time was 240 minutes (range: 210-300 minutes). The mean blood loss was 150 mL (range: 100-200 mL). One patient (10%) had cervical anastomotic leak on the ninth postoperative day, which was resolved spontaneously. One patient (10%) had proximal anastomotic stricture, requiring dilatation thrice. One patient (10%) had the transient left recurrent laryngeal nerve paresis, which was resolved spontaneously. All the patients are on oral solid diet. The followup ranged from 5 months to 2 years. Minimal access substernal colonic transposition is feasible and efficacious in restoring alimentary continuity in corrosive strictures.
腐蚀性上消化道狭窄传统上通过开放手术治疗。手术技术的进步使得这些狭窄能够以微创方式处理。对2014年至2015年期间接受微创治疗的腐蚀性狭窄患者进行了审计。结肠游离和胸骨后隧道构建通过腹腔镜进行。以左结肠血管为基础的顺蠕动结肠/回结肠段在小切口辅助下经胸骨后转移至颈部。除接受咽喉切除术或部分喉切除术的患者采用咽结肠/梨状窝-回肠吻合术外，所有患者近端吻合均为食管结肠侧侧吻合。所有患者远端吻合均为结肠空肠吻合和结肠结肠/回结肠吻合。术后第一天开始肠内营养并下床活动。术后第七天吞咽造影正常后开始口服营养。患者在门诊接受随访。10名年龄在19至40岁之间的成年人接受了酸诱导狭窄的治疗。所有患者食管和胃均有多处狭窄。此外，2例患者十二指肠受累，3例患者咽和喉狭窄。2例患者接受了咽喉切除术。1例患者接受了部分喉切除术。平均手术时间为240分钟（范围：210 - 300分钟）。平均失血量为150毫升（范围：100 - 200毫升）。1例患者（10%）术后第九天出现颈部吻合口漏，自行愈合。1例患者（10%）出现近端吻合口狭窄，需扩张三次。1例患者（10%）出现短暂性左侧喉返神经麻痹，自行恢复。所有患者均能正常进食固体食物。随访时间为5个月至2年。微创胸骨后结肠转位在恢复腐蚀性狭窄患者的消化道连续性方面是可行且有效的。
