Stone M M, Fonkalsrud E W, Mahour G H, Weitzman J J, Takiff H
Ann Surg. 1986 Apr;203(4):346-51. doi: 10.1097/00000658-198604000-00002.
During a 21-year period, 39 colon interposition operations were performed on 37 children at the UCLA Medical Center and the Childrens Hospital of Los Angeles. The average age at the time of operation was 5.8 years. The indications for operation were esophageal atresia in 23 patients and other benign strictures in 14 patients. The duration of patient follow-up ranged from 6 months to 21 years (mean: 9.7 years). The most common complications were esophagocolonic anastomotic leak (12), esophagocolonic anastomotic stricture (14), pneumonia, and pneumothorax. Fourteen of the 25 patients with retrosternal colon interposition had complications (56%), whereas 10 of 14 patients with left thoracic colon interposition had complications (71%). One patient died (mortality: 3%) after left thoracic interposition because of severe respiratory distress associated with other malformations. Each of the 18 patients with isoperistaltic colon interposition showed rapid transit and emptying, provided that obstruction or extensive dilatation did not occur; reverse colon segments were more dilated and emptied more slowly. The 25 patients with retrosternal colon segments had less colonic distension with better emptying than did the 14 patients with left thoracic interposition. Thirty-two of the 36 children increased their weight percentile after colon interposition. Within 2 years after cervical anastomotic stricture or leak, 78% of these children were asymptomatic and gaining weight. Thirty-one of the 37 patients (84%) had excellent results with colon interposition, with a mean follow-up of 9.7 years. Most of the major postoperative complications occurred within the first few weeks and were corrected during the first few months after operation. Preservation of the esophagus should be the surgeon's first priority; however, prolonged attempts to elongate the esophagus for anastomosis in certain patients with long-gap esophageal atresia have been more hazardous in our experience than has colon interposition.
在21年的时间里，加州大学洛杉矶分校医疗中心和洛杉矶儿童医院对37名儿童进行了39次结肠间置手术。手术时的平均年龄为5.8岁。手术指征为23例食管闭锁和14例其他良性狭窄。患者的随访时间为6个月至21年（平均：9.7年）。最常见的并发症是食管结肠吻合口漏（12例）、食管结肠吻合口狭窄（14例）、肺炎和气胸。25例胸骨后结肠间置患者中有14例出现并发症（56%），而14例左胸结肠间置患者中有10例出现并发症（71%）。1例左胸间置术后患者因与其他畸形相关的严重呼吸窘迫死亡（死亡率：3%）。18例顺蠕动结肠间置患者中，每例均表现出快速转运和排空，前提是未发生梗阻或广泛扩张；反向结肠段扩张更明显，排空更慢。25例胸骨后结肠段患者的结肠扩张程度低于14例左胸间置患者，排空情况更好。36例儿童中有32例在结肠间置术后体重百分位数增加。在颈部吻合口狭窄或漏后2年内，这些儿童中有78%无症状且体重增加。37例患者中有31例（84%）结肠间置效果良好，平均随访9.7年。大多数主要术后并发症发生在最初几周内，并在术后最初几个月内得到纠正。保留食管应是外科医生的首要任务；然而，根据我们的经验，在某些长间隙食管闭锁患者中，为吻合而长时间试图延长食管比结肠间置更具危险性。
