Bizzoca C, Pisicchio S, Torchia G, Vincenti L
G Chir. 2019 Jul-Aug;40(4):355-359.
Esophageal reconstruction with colonic or jejunal segment is a second choice treatment when the stomach is injured or not adequate for use. These reconstructions, whether pedicled or as free jejunal graft, are technically demanding and they are associated with high rate of morbidity and mortality. Complications are mainly due to insufficient blood supply and therefore anastomotic leak or stricture and graft necrosis. We describe the case of a 51-year-old psychiatric man with diagnosis of esophageal perforation after ingestion of metallic razor blades for suicide intent. The patient was treated at an outside hospital with endoscopic removal of the blades and apposition of endoscopic clips, be cause of esophageal mucosal perforation. Nevertheless, he developed a septic status caused by mediastinitis. The patient underwent several interventions to solve the sepsis and after complete recovery he was referred to our Department for esophageal reconstruction. During surgery we found that the stomach was unavailable for reconstruction, therefore a left colonic interposition pedicled on the left colic vessels was performed through the retrosternal route. During the postoperative course the patient developed acute respiratory failure and suppuration of the cervical wound. The postoperative course was complicated because of the poor compliance of the patient due to his psychiatric disorder. He was discharged in postoperative day (POD) 42 in good clinical conditions, on oral-only diet. Colonic interposition through the retrosternal route after esophagectomy is a technically demanding procedure, associated with high morbidity and mortality, but it is a feasible option when the stomach is not available for reconstruction.
当胃部受损或不适合用于重建时，采用结肠或空肠段进行食管重建是一种二线治疗选择。这些重建手术，无论是带蒂的还是游离空肠移植，技术要求都很高，并且与高发病率和死亡率相关。并发症主要是由于血供不足，进而导致吻合口漏、狭窄以及移植组织坏死。我们描述了一名51岁男性精神病患者的病例，该患者因意图自杀吞食金属剃须刀片后被诊断为食管穿孔。由于食管黏膜穿孔，患者在外院接受了内镜下刀片取出及内镜夹夹闭治疗。然而，他因纵隔炎发展为脓毒症状态。患者接受了多次干预以解决脓毒症问题，完全康复后被转诊至我们科室进行食管重建。手术中我们发现无法用胃进行重建，因此通过胸骨后途径进行了以左结肠血管为蒂的左结肠间置术。术后患者出现了急性呼吸衰竭和颈部伤口化脓。由于患者精神疾病导致依从性差，术后病程较为复杂。他在术后第42天临床状况良好，仅经口进食出院。食管切除术后经胸骨后途径进行结肠间置术是一项技术要求高的手术，与高发病率和死亡率相关，但当无法用胃进行重建时，它是一种可行的选择。
