Handaya Yuda, Sunardi Mukhamad
Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Ann Coloproctol. 2017 Aug;33(4):150-155. doi: 10.3393/ac.2017.33.4.150. Epub 2017 Aug 31.
Because most surgeons perform an esophagectomy and colonic transposition as the main reconstruction method for patients with esophageal stenosis caused by swallowing corrosive materials, we report 2 cases in which ileocolonic transposition was used to treat such patients. Both patients displayed stenosis in the middle third of the esophagus. Their chief complaint was dysphagia. Ileocolonic transposition using vascularization of the Drummond and ileal arteries was followed by a prepared ileocolic graft by ligating ileocolic vessels. We performed an ileocolonic transposition esophagogastric bypass without an esophagectomy. All surgeries resulted in minimal intraoperative bleeding. Patients experienced no leakage, postoperative fistulas, dysphagia, or postoperative reflux. Three weeks after surgery, 1 patient experienced reversible hoarseness caused by extensive laryngeal-nerve manipulation. Cumulatively, ileocolonic transposition with cervical anastomosis for the treatment of patients with esophageal stenosis caused by corrosive esophageal injury can be considered to be an antireflux treatment because the ileocaecal sphincter is maintained.
由于大多数外科医生将食管切除术和结肠转位术作为吞咽腐蚀性物质所致食管狭窄患者的主要重建方法,我们报告2例采用回结肠转位术治疗此类患者的病例。两名患者均表现为食管中段三分之一处狭窄。他们的主要症状是吞咽困难。通过结扎回结肠血管,利用德拉蒙德动脉和回肠动脉的血管化进行回结肠转位,随后制备回结肠移植物。我们在未进行食管切除术的情况下进行了回结肠转位食管胃旁路术。所有手术术中出血均极少。患者未出现渗漏、术后瘘、吞咽困难或术后反流。术后三周,1例患者因广泛的喉返神经操作出现可逆性声音嘶哑。总体而言,由于保留了回盲括约肌,采用颈部吻合的回结肠转位术治疗腐蚀性食管损伤所致食管狭窄患者可被视为一种抗反流治疗。