Isozaki Tetsuro, Murakami Kentaro, Yamanouchi Eigoro, Uesato Masaya, Toyozumi Takeshi, Koide Yoshio, Tsukamoto Soichiro, Sakata Haruhito, Hayano Koichi, Kano Masayuki, Hayashi Hideki, Matsubara Hisahiro
Department of Frontier Surgery Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan.
Department of Radiology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara-shi, Tochigi, 329-2763, Japan.
Surg Case Rep. 2020 Aug 17;6(1):213. doi: 10.1186/s40792-020-00974-y.
Esophagostomy is important in the treatment of esophageal cancer. However, esophagectomy has a higher risk of postoperative complications. Treatment for complications is often difficult, and in some cases, oral intake is no longer possible. Recently, magnetic compression anastomosis (MCA) was developed; it is a relatively safe method of anastomosis that does not require surgery in patients with stricture, obstruction, or dehiscence of the anastomosis after surgery.
The patient was a 76-year-old Japanese man. He underwent esophagectomy with a three-field dissection for esophageal cancer. A cervical esophagostomy and chest drainage were performed for necrosis of the gastric tube. Following infection control, colon interposition was performed. However, after the operation, the colon necrotized and formed an abscess. Drainage controlled the infection, but the colon was completely obstructed. The patient was referred to our hospital to restore oral ingestion. Contrast studies showed that the length of the occlusion was 10 mm. The reconstruction was examined; reanastomosis by surgery was judged to be a high risk, so the strategy of anastomosis by MCA was adopted. In the operation, the anterior chest was opened to expose the colon, and a magnet was inserted directly into the blind end of the colon. The magnet was guided to the blind end of the esophagus using an oral endoscope. Two weeks after MCA, a contrast study confirmed the passage of the contrast agent from the esophagus to the colon. The patient eventually took 18 bougies after the MCA. However, since then, he has not needed a bougie. As of 1 year and 8 months after the MCA, the patient is living at home with oral intake restored.
MCA is an effective and safe treatment for complete stenosis after esophageal cancer surgery.
食管造口术在食管癌治疗中很重要。然而，食管切除术术后并发症风险较高。并发症的治疗往往困难，在某些情况下，无法再经口进食。最近，磁压缩吻合术（MCA）得以开发；对于术后吻合口狭窄、梗阻或裂开的患者，它是一种相对安全的吻合方法，无需手术。
患者为一名76岁的日本男性。他因食管癌接受了三野清扫食管切除术。因胃管坏死进行了颈部食管造口术和胸腔引流。感染得到控制后，进行了结肠代食管术。然而，术后结肠坏死并形成脓肿。引流控制了感染，但结肠完全梗阻。该患者被转诊至我院以恢复经口进食。造影检查显示梗阻长度为10毫米。对重建方案进行了评估；手术重新吻合被判定风险较高，因此采用了MCA吻合策略。手术中，打开前胸暴露结肠，将一块磁铁直接插入结肠盲端。使用口腔内窥镜将磁铁引导至食管盲端。MCA术后两周，造影检查证实造影剂从食管通过至结肠。MCA术后患者最终接受了18次探条扩张。然而，自那以后，他不再需要探条扩张。截至MCA术后1年8个月，患者在家中生活，已恢复经口进食。
MCA是食管癌手术后完全狭窄的一种有效且安全的治疗方法。
