University Hospital of Wales, Heath Park, Cardiff, Wales, CF14 4XN, UK.
J Gastrointest Surg. 2018 Jun;22(6):1104-1111. doi: 10.1007/s11605-018-3735-8. Epub 2018 Mar 8.
Colonic interposition is a second-line option after oesophagectomy when a gastric neo-oesophagus is not viable. There is no consensus on the optimum anatomical colonic conduit (right or left), or route of placement (posterior mediastinal, retrosternal or subcutaneous). The aim of this review was to determine the optimum site and route of neo-oesophageal conduit after adult oesophagectomy.
PubMed, MEDLINE, and the Cochrane Library (January 1985 to January 2017) were systematically searched for studies which reported outcomes following colonic interposition in adults. The outcome measures were overall morbidity and mortality.
Twenty-seven observational studies involving 1849 patients [1177 males; median age (range) 60.5 (18-84) years] undergoing colonic interposition for malignant (n = 697) and benign (n = 1152) pathology were analysed. Overall pooled morbidity of left vs. right colonic conduit was 15.7% [95% CI (11.93-19.46), p < 0.001] and 18.7% [95% CI (15.58-21.82), p < 0.001] respectively. Overall pooled mortality of left vs. right colonic conduit was 6.5% [95% CI (4.55-8.51), p < 0.001] and 10.1% [95% CI (7.35-12.82), p < 0.001] respectively. Retrosternal route placement was associated with the lowest overall pooled morbidity and mortality of 9.2% [95% CI (6.48-11.99), p < 0.001] and 4.8% [95% CI (3.74-5.89), p < 0.001] respectively.
Left colonic conduits placed retrosternally were safest.
当胃新食管不可用时，结肠间置术是食管切除术后的二线选择。对于最佳解剖结肠导管（右侧或左侧）或放置位置（后纵隔、胸骨后或皮下），尚无共识。本综述的目的是确定成人食管切除术后新食管导管的最佳部位和途径。
系统检索了 1985 年 1 月至 2017 年 1 月期间发表的关于成人结肠间置术的 PubMed、MEDLINE 和 Cochrane 图书馆的研究，以评估文献报道的结果。结局指标是总发病率和死亡率。
共分析了 27 项观察性研究，共纳入 1849 例患者[1177 例男性；中位年龄（范围）60.5（18-84）岁]，因恶性（n=697）和良性（n=1152）病变接受结肠间置术。左侧与右侧结肠导管的总发病率分别为 15.7%（95%CI（11.93-19.46），p<0.001）和 18.7%（95%CI（15.58-21.82），p<0.001）。左侧与右侧结肠导管的总死亡率分别为 6.5%（95%CI（4.55-8.51），p<0.001）和 10.1%（95%CI（7.35-12.82），p<0.001）。胸骨后入路与最低的总发病率和死亡率相关，分别为 9.2%（95%CI（6.48-11.99），p<0.001）和 4.8%（95%CI（3.74-5.89），p<0.001）。
胸骨后左侧结肠导管放置最为安全。
