Fujioka M, Hayashida K, Fukui K, Ishiyama S, Saijo H, Taniguchi K
Department of Plastic and Reconstructive Surgery, Nagasaki University, and Department of Plastic and Reconstructive Surgery, Clinical Research Center, National Hospital Organization Nagasaki Medical Center.
Departments of Plastic and Reconstructive Surgery.
Dis Esophagus. 2017 Aug 1;30(8):1-6. doi: 10.1093/dote/dox024.
Gastric pull-up is a common procedure to reconstruct the continuity of the upper digestive tract after esophageal resection. However, this technique sometimes causes postoperative anastomotic leakage or stricture, resulting from insufficient blood flow at the distal end. To overcome this problem, additional microvascular venous anastomoses were performed. The purpose of this study was to compare the outcomes of post-surgical anastomotic leakage and stricture in patients with and without additional microvascular venous superdrainage after cervical esophageal and hypopharyngeal resection and gastric tube reconstruction. A total of 29 consecutive patients with esophageal or hypopharyngeal cancer who underwent total esophagectomy and hypopharyngectomy with gastric tube reconstruction in the National Organization Nagasaki Medical Center between April 2014 and May 2016 were analyzed in this study. Of these patients, 20 underwent additional venous anastomoses (superdrainage group), and 9 did not undergo additional procedures (standard group). We compared the frequency of post-surgical stricture and leakage in the two groups retrospectively. Three of nine patients (33.3%) developed postoperative leakage in the standard group, and 1 of 20 (5.0%) did so in the superdrainage group. Six of nine patients (66.7%) showed postoperative anastomotic stricture in the standard group, but none did so in the superdrainage group. Patients who did not undergo additional venous superdrainage were significantly more likely to develop postsurgical leakage (P < 0.05, Chi-square test) and anastomotic stricture (P < 0.001, Chi-square test). Our study revealed that only additional venous anastomoses could reduce the incidence of postoperative anastomotic leakage and stricture. This procedure is of merit to perform after total esophagectomy and hypopharyngectomy with gastric tube reconstruction.
胃上提术是食管切除术后重建上消化道连续性的常用手术。然而，该技术有时会导致术后吻合口漏或狭窄，这是由远端血流不足引起的。为克服这一问题，进行了额外的微血管静脉吻合术。本研究的目的是比较在颈段食管和下咽切除及胃管重建术后，有或没有额外微血管静脉引流的患者手术吻合口漏和狭窄的结果。本研究分析了2014年4月至2016年5月期间在长崎医疗中心接受全食管切除术和下咽切除术并进行胃管重建的29例连续的食管癌或下咽癌患者。在这些患者中，20例进行了额外的静脉吻合术（引流组），9例未进行额外手术（标准组）。我们回顾性比较了两组手术狭窄和漏的发生率。标准组9例患者中有3例（33.3%）发生术后漏，引流组20例中有1例（5.0%）发生术后漏。标准组9例患者中有6例（66.7%）出现术后吻合口狭窄，而引流组无一例出现。未进行额外静脉引流的患者术后发生漏（P<0.05，卡方检验）和吻合口狭窄（P<0.001，卡方检验）的可能性显著更高。我们的研究表明，仅额外的静脉吻合术就能降低术后吻合口漏和狭窄的发生率。该手术在全食管切除术和下咽切除术并进行胃管重建术后进行是有价值的。
