Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata Prefecture, 950-1197, Japan.
Updates Surg. 2021 Dec;73(6):2239-2246. doi: 10.1007/s13304-021-01033-3. Epub 2021 Mar 20.
When colonic graft is used as an esophageal substitute after esophagectomy, one or two feeding vessels of the colon are cut to obtain sufficient length, the graft is passed via the subcutaneous route, and microvascular anastomosis is often used to avoid fatal complications. Sixteen consecutive ileo-right colonic reconstructions via the posterior mediastinal or retrosternal route with preservation of all four colonic vessels were performed in the past eight years. We presented the surgical technique and evaluation of this surgical method. In 15 out of 16 consecutive cases, the graft could be pulled up to the neck through the posterior mediastinal or retrosternal route while preserving all four colonic vessels. Reconstruction was not possible in one patient because of ileocolic vessel injury during colonic mobilization. Anastomotic leakage occurred in three patients, but all were minor and were treated conservatively. There were no patients with graft necrosis resulting from insufficient blood supply. Ileo-right colonic reconstruction with preservation of all four colonic vessels through the posterior mediastinal or retrosternal route is a safe and feasible procedure and is considered the first choice for colonic reconstruction as an esophageal substitute.
当结肠移植物被用作食管切除术后的替代物时，会切断结肠的一条或两条供血血管以获得足够的长度，然后通过皮下途径将移植物穿过，通常采用微血管吻合术来避免致命的并发症。在过去的八年中，我们通过后纵隔或胸骨后途径进行了 16 例连续的回肠-右半结肠重建，保留了所有四条结肠血管。我们介绍了这种手术方法的手术技术和评估。在 16 例连续病例中，15 例在保留所有四条结肠血管的情况下，可以通过后纵隔或胸骨后途径将移植物向上拉至颈部。有 1 例患者因结肠游离时回结肠血管损伤而无法重建。3 例患者发生吻合口漏，但均为轻度，经保守治疗。没有因血供不足导致移植物坏死的患者。通过后纵隔或胸骨后途径保留所有四条结肠血管的回肠-右半结肠重建是一种安全可行的手术，被认为是作为食管替代物进行结肠重建的首选方法。
