Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
Curr Med Sci. 2019 Jun;39(3):415-418. doi: 10.1007/s11596-019-2052-0. Epub 2019 Jun 17.
The colon is an alternative graft organ for esophageal reconstruction. The present study reviewed our experience with the colon interposition for esophageal replacement following corrosive ingestion, to evaluate the outcomes of colon interposition based on our surgical experience. The clinical data of 119 patients who underwent colon interposition for esophageal replacement from January 2005 to March 2017 were retrospectively analyzed. The routes of the colon interposition were retrosternal in 119 (100%). The median operative time was 390 min (range: 290-610 min) and the median blood loss was 615 mL (range: 270-2500 mL). Of these 119 patients, the cervical anastomosis was performed at the hypopharynx (n=20, 16.8%), the larynx (n=3, 2.5%), and the cervical esophagus (n=96, 80.7%). Five patients experienced cervical anastomotic leakage (4 cases for esophagus-colon, and one for hypopharynx-colon). One patient experienced wound infection of the abdominal wall. Three patients had injury of recurrent laryngeal nerve and hoarseness. Three patients had stress ulcer with bleeding and treated with octreotide. Two patients suffered from incomplete intestinal obstruction. The postoperative follow-up was made for 12 months in all patients and all of them were alive. In conclusion, The colon is well-suited for esophageal reconstruction. The selection of the colon graft should be flexible and be based on the inspection of blood supply and the length needed. We must therefore make every effort to reduce the number of postoperative complications, and improve the quality of life for patients.
结肠是替代食管重建的一种移植物。本研究回顾了我们在腐蚀性摄入后使用结肠间置术进行食管替代的经验,以根据我们的手术经验评估结肠间置术的结果。回顾性分析了 2005 年 1 月至 2017 年 3 月期间 119 例行结肠间置术治疗腐蚀性摄入后食管替代的患者的临床资料。结肠间置术的途径均为胸骨后(119 例,100%)。手术时间中位数为 390 分钟(范围:290-610 分钟),术中出血量中位数为 615 毫升(范围:270-2500 毫升)。在这 119 例患者中,20 例(16.8%)在咽下部、3 例(2.5%)在喉部、96 例(80.7%)在颈部食管行颈吻合术。5 例患者发生颈吻合口漏(4 例为食管-结肠,1 例为咽-结肠)。1 例患者发生腹壁伤口感染。3 例患者出现喉返神经损伤和声音嘶哑。3 例患者发生应激性溃疡伴出血,用奥曲肽治疗。2 例患者发生不完全性肠梗阻。所有患者均进行了 12 个月的术后随访,均存活。结论:结肠非常适合进行食管重建。结肠移植物的选择应灵活,并根据血供和所需长度进行检查。因此,我们必须努力减少术后并发症的发生,提高患者的生活质量。