Nakamura T, Yamamoto M, Yamazato T, Kanaji S, Takahashi H, Inoue T, Oshikiri T, Tanaka H, Suzuki S, Okita Y, Kakeji Y
Division of Gastrointestinal Surgery.
Department of Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
Dis Esophagus. 2017 Sep 1;30(9):1-7. doi: 10.1093/dote/dox077.
Aortoesophageal fistula is a critical and life-threatening disease. The cardiovascular strategy for graft replacement has been widely discussed. However, the surgical strategy of esophageal resection and reconstruction for aortoesophageal fistula has rarely been discussed. The objective of this study is to establish a surgical strategy and procedure of esophageal resection and reconstruction for aortoesophageal fistula. Eleven patients with aortoesophageal fistula who underwent aortic graft replacement and esophagectomy between 2008 and 2015 at Kobe University Hospital were enrolled in this study. Patient characteristics, operative methods, and clinical outcomes were obtained by retrospective chart review. All 11 patients underwent graft replacement, esophagectomy, and omental wrapping. Ten esophagectomies were simultaneously accomplished in the same operative field as aortic graft replacement. Seven patients underwent subtotal esophagectomy from a left thoracotomy, and three patients underwent upper hemiesophagectomy from a median sternotomy. The other patient underwent staged esophagectomy from a right thoracotomy. Seven of 11 patients (63.6%) successfully underwent staged esophageal reconstruction. Pedicled jejunal transfer with supercharge and superdrainage were performed in six patients, and ileocecal reconstruction was performed in one patient. Median survival time in the patients with esophageal reconstruction was 21 months while that in the patients without esophageal reconstruction was 10 months. Six of 7 patients (85.7%) who underwent esophageal reconstructions were alive. Our surgical strategy for aortoesophageal fistula, which includes simultaneous graft replacement and esophagectomy in the same operative field and staged reconstruction by pedicled jejunal transfer to ensure omental wrapping, is feasible and promising.
主动脉食管瘘是一种危急且危及生命的疾病。关于移植置换的心血管策略已得到广泛讨论。然而，针对主动脉食管瘘的食管切除与重建的手术策略却鲜有讨论。本研究的目的是建立一种针对主动脉食管瘘的食管切除与重建的手术策略及操作方法。本研究纳入了2008年至2015年期间在神户大学医院接受主动脉移植置换和食管切除术的11例主动脉食管瘘患者。通过回顾性病历审查获取患者特征、手术方法和临床结果。所有11例患者均接受了移植置换、食管切除术和网膜包裹术。10例食管切除术与主动脉移植置换在同一手术视野中同时完成。7例患者经左胸切口行次全食管切除术，3例患者经胸骨正中切口行食管上段切除术。另1例患者经右胸切口分期行食管切除术。11例患者中有7例（63.6%）成功接受了分期食管重建。6例患者采用带蒂空肠移植并增压和超引流，1例患者采用回盲部重建。接受食管重建的患者中位生存时间为21个月，未接受食管重建的患者中位生存时间为10个月。接受食管重建的7例患者中有6例（85.7%）存活。我们针对主动脉食管瘘的手术策略，包括在同一手术视野中同时进行移植置换和食管切除术，并通过带蒂空肠移植进行分期重建以确保网膜包裹，是可行且有前景的。
