Fujii Masakazu, Okada Naoya, Shichinohe Ryuji, Sakurai Yasuo, Kinoshita Yoshihiro
Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
Department of Plastic Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
Int J Surg Case Rep. 2021 May;82:105876. doi: 10.1016/j.ijscr.2021.105876. Epub 2021 Apr 8.
Gastric remnant reconstruction is commonly used for esophagectomy reconstruction. However, standard reconstruction cannot be performed in some patients with a specific medical history. We report a case of esophagectomy and gastric remnant reconstruction with left gastroepiploic artery (LGEA) supercharge to treat esophageal cancer in a patient in whom the right gastroepiploic artery (RGEA) had previously been occluded.
A 65-year-old man underwent endoscopic submucosal dissection for thoracic esophageal squamous cell carcinoma. He was diagnosed with pathological T1b cancer with lymphatic invasion and a positive horizontal margin, and needed curative resection. He had previously undergone RGEA embolization to treat a pseudoaneurysm caused by chronic pancreatitis. We successfully performed esophagectomy and gastric remnant reconstruction with preoperative left gastric artery embolization and intraoperative LGEA supercharge.
An absent RGEA blood supply is not always a contraindication for gastric remnant reconstruction when the collateral blood flows are well developed and supercharge can maintain the blood supply to the gastric remnant.
Gastric remnant reconstruction with preoperative selective arterial embolization and intraoperative supercharge represents one of the options for high-risk patients with an altered gastric blood supply.
胃残端重建常用于食管癌切除术后的重建。然而，一些有特定病史的患者无法进行标准重建。我们报告一例食管癌患者，其右胃网膜动脉（RGEA）先前已闭塞，采用左胃网膜动脉（LGEA）增压进行食管切除及胃残端重建的病例。
一名65岁男性因胸段食管鳞状细胞癌接受内镜下黏膜下剥离术。他被诊断为伴有淋巴侵犯及水平切缘阳性的病理T1b期癌症，需要进行根治性切除。他此前曾接受RGEA栓塞术以治疗慢性胰腺炎引起的假性动脉瘤。我们通过术前左胃动脉栓塞及术中LGEA增压成功实施了食管切除术及胃残端重建。
当侧支血流发育良好且增压能维持胃残端血供时，RGEA血供缺失并不总是胃残端重建的禁忌证。
术前选择性动脉栓塞及术中增压的胃残端重建是胃血供改变的高危患者的选择之一。
