Li Baofei, Wang Haiyang, Liu Jun, Mu Xiaosong, Xu Feng, Deng Di, Qiao Yixin, Wang Shipin, Chen Fei
Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Otolaryngology, Head and Neck Surgery, Langzhong People's Hospital, Langzhong, China.
Front Surg. 2023 Jan 6;9:905241. doi: 10.3389/fsurg.2022.905241. eCollection 2022.
Postoperative benign esophageal anastomotic leakage and stenosis are common complications after esophagectomy. Treatment options for anastomosis stenosis include endoscopic mechanical dilation, dilation-combined steroid injection, incisional therapy, stent placement, and self-bougienage. However, long-segmental cervicothoracic esophageal stenosis and cutaneous fistula are always refractory to conservative treatments and are clinically challenging. When lesions extend well below the thoracic inlet, transthoracic esophagectomy and alimentary canal reconstruction seem to be the common choice but are susceptible to perioperative mortality and donor-site sequelae, especially for patients with poor health conditions. In this report, we present a novel surgical approach for cervicothoracic esophageal stenosis and fistula partial sternectomy and reconstruction with a pedicled thoracoacromial artery perforator flap. No recurrence or complications occurred throughout 3 months of follow-up. This case study adds new perspectives to the treatment of anastomotic stenosis.
术后良性食管吻合口漏和狭窄是食管切除术后常见的并发症。吻合口狭窄的治疗选择包括内镜下机械扩张、扩张联合类固醇注射、切开治疗、支架置入和自我扩张。然而，长节段颈胸段食管狭窄和皮肤瘘对保守治疗往往无效，在临床上具有挑战性。当病变延伸至胸廓入口以下时，经胸食管切除术和消化道重建似乎是常见的选择，但易发生围手术期死亡和供区后遗症，尤其是对于健康状况较差的患者。在本报告中，我们提出了一种治疗颈胸段食管狭窄和瘘的新手术方法——部分胸骨切除术并带蒂胸肩峰动脉穿支皮瓣重建。在3个月的随访中未出现复发或并发症。本病例研究为吻合口狭窄的治疗增添了新的视角。
