Guo Wei, Yang Su, Li Hecheng
Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Ann Transl Med. 2018 Apr;6(7):117. doi: 10.21037/atm.2017.09.14.
Esophagectomy is usually performed to resect esophageal cancer. However, there are numerous other indications for esophagectomy, including Barrett's esophagus with high-grade dysplasia (HGD) and some benign diseases such as obstruction, end-stage achalasia, esophagus perforation or disruption, benign neoplasm, and severe caustic injury. For these patients, esophagectomy could relieve their symptom obviously. However, esophagectomy causes huge trauma, induces quite high morbidity and mortality, and may decreases patients' quality of life obviously due to postoperative reflux, dumping, anastomotic stricture and other complications. Accordingly, the considerations of a surgery must be carefully deliberated, including the underlying disorder, lesions localization, extent of disease, and options for esophageal replacement. For patients received esophagectomy and alimentary tract reconstruction, gastric conduit is the most common used replacement organ, then colon and jejunum. This review demonstrated the importance and technical experience of esophagectomy with gastric conduit reconstruction for benign diseases.
食管切除术通常用于切除食管癌。然而，食管切除术还有许多其他适应证，包括伴有高级别异型增生（HGD）的巴雷特食管以及一些良性疾病，如梗阻、终末期贲门失弛缓症、食管穿孔或破裂、良性肿瘤和严重的腐蚀性损伤。对于这些患者，食管切除术可明显缓解其症状。然而，食管切除术会造成巨大创伤，导致较高的发病率和死亡率，并且由于术后反流、倾倒综合征、吻合口狭窄及其他并发症，可能会明显降低患者的生活质量。因此，必须仔细权衡手术的各项因素，包括潜在疾病、病变部位、疾病范围以及食管替代方案。对于接受食管切除术和消化道重建的患者，胃管道是最常用的替代器官，其次是结肠和空肠。本综述阐述了采用胃管道重建进行食管切除术治疗良性疾病的重要性和技术经验。
