Department of Surgery, Medical Center, Pécs University, Ifjúság u. 13, 7624, Pécs, Hungary.
Dysphagia. 2023 Oct;38(5):1323-1332. doi: 10.1007/s00455-023-10557-2. Epub 2023 Jan 31.
Dysphagia occurs temporarily or permanently following esophageal replacement in at least half of the cases. Swallowing disorder, in addition to severe decline in the quality of life, can lead to a deterioration of the general condition, which may lead to death if left untreated. For this reason, their early detection and treatment are a matter of importance. Between 1993 and 2012, 540 esophageal resections were performed due to malignant tumors at the Department of Surgery, Medical Center of the University of Pécs. Stomach was used for replacement in 445 cases, colon in 38 cases, and jejunum in 57 cases. The anastomosis with a stomach replacement was located to the neck in 275 cases and to the thorax in 170 cases. The colon was pulled up to the neck in each case. There were 29 cases of free jejunal replacements located to the neck and 28 cases with a Roux loop reconstruction located to the thorax. Based on the literature data and own experience, the following were found to be the causes of dysphagia in the order of frequency: anastomotic stenosis, conduit obstruction, peptic and ischemic stricture, foreign body, local recurrence, functional causes, new malignant tumor in the esophageal remnant, and malignant tumor in the organ used for replacement. Causes may overlap each other, and their treatment may be conservative or surgical. The causes of many dysphagic complications might be prevented by improving the anastomosis technique, by better preservation the blood supply of the substitute organ, by consistently applying a functional approach, and by regular follow-up.
在至少一半的情况下，食管替换术后会暂时或永久出现吞咽困难。吞咽障碍除了严重降低生活质量外，还可能导致一般状况恶化，如果不治疗，甚至可能导致死亡。因此，早期发现和治疗这些问题非常重要。在 1993 年至 2012 年期间，皮塞医学中心外科系共进行了 540 例恶性肿瘤食管切除术。其中 445 例使用胃进行替代，38 例使用结肠，57 例使用空肠。275 例胃替代吻合口位于颈部，170 例位于胸部。每例结肠均被向上拉至颈部。29 例游离空肠替代位于颈部，28 例 Roux 环重建位于胸部。基于文献数据和自身经验，按照发生频率，将吞咽困难的原因总结如下：吻合口狭窄、导管阻塞、消化性和缺血性狭窄、异物、局部复发、功能原因、食管残端新发恶性肿瘤和替代器官的恶性肿瘤。原因可能相互重叠，其治疗可能是保守的，也可能是手术的。通过改进吻合技术、更好地保留替代器官的血液供应、始终采用功能性方法以及定期随访，可能预防许多吞咽困难并发症的发生。
