Saeki M, Tsuchida Y, Ogata T, Nakano M, Akiyama H
Department of Surgery, National Children's Hospital, Tokyo, Japan.
J Pediatr Surg. 1988 May;23(5):483-9. doi: 10.1016/s0022-3468(88)80454-8.
Since 1969, jejunal interpositions have been carried out in 19 patients for esophageal replacement. A segment of the upper jejunum was used to bridge the gap in the right thoracic cavity. The distal esophagus and its sphincteric mechanism was preserved in all but four patients, who had peptic strictures. Early postoperative complications such as total necrosis of the graft, perforation of the graft, and anastomotic leak developed in three patients (16%). There were no operative deaths but there were two later deaths (11%). We were able to follow 12 patients over a long term. Among these 12 patients there were two anastomotic strictures, one of which was dilated successfully by bouginage, and one marked redundancy of the jejunum which necessitated surgical correction. Both height and weight were lower than -2 SD on a Japanese standard growth curve in two patients who had anastomotic strictures. Transient stagnation of swallowed barium at the lower esophagus was the common finding; it was observed in seven cases (58%). Only three patients (25%) complained of occasional feelings of delay in swallowing. Stagnation with a mildly redundant jejunum was the common radiologic finding in these three patients. Reflux of the gastric content into the esophagus did not occur. All the patients, except one who still has dysphagia due to anastomotic stricture, can eat anything they wish at almost normal speed. These long-term results indicate that jejunal interposition with preservation of the lower esophagus is a recommendable procedure for esophageal replacement.
自1969年以来，19例患者接受了空肠间置术以替代食管。取一段上段空肠用于在右胸腔内搭桥。除4例患有消化性狭窄的患者外，其余所有患者均保留了远端食管及其括约肌机制。3例患者（16%）出现了早期术后并发症，如移植物完全坏死、移植物穿孔和吻合口漏。无手术死亡病例，但有2例后期死亡（11%）。我们能够长期随访12例患者。在这12例患者中，有2例吻合口狭窄，其中1例通过探条扩张成功，1例空肠明显冗长，需要手术矫正。2例患有吻合口狭窄的患者，其身高和体重在日本标准生长曲线上均低于-2标准差。吞咽的钡剂在下段食管短暂停滞是常见表现；7例（58%）观察到这种情况。只有3例患者（25%）偶尔抱怨吞咽时有延迟感。这3例患者常见的放射学表现为空肠轻度冗长伴停滞。胃内容物未反流至食管。除1例因吻合口狭窄仍有吞咽困难的患者外，所有患者都能以几乎正常的速度吃任何想吃的东西。这些长期结果表明，保留下段食管的空肠间置术是一种值得推荐的食管替代手术。
