Wozniak Slawomir, Grabowski Krzysztof, Tabola Renata
Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Chalubinskiego 6a, Wroclaw, 50-368, Poland.
Department of Surgery Teaching, Wroclaw Medical University, Marii Curie- Sklodowskiej 66, Wroclaw, 50-369, Poland.
Sci Rep. 2025 Aug 5;15(1):28532. doi: 10.1038/s41598-025-14371-8.
Anatomy is the primary factor in planning and performing reconstructive surgery of the oesophagus. When it becomes necessary to replace the natural, pathologically obstructed oesophagus-for example, after corrosive intake-a tube can be created using the stomach or intestine. We performed intestine-based reconstructions of injured and obliterated oesophagi in more than 300 patients. Of these, 147 (60 women, 70 men, and 17 children: 7 girls and 10 boys) treated between 1990 and 2010 were analysed in this study. The decision to use the intestine, whether large or small, as a substitute was based on its vascular supply, which was assessed intraoperatively. The reconstruction was performed using a pedicled intestinal segment, with the colon utilized in approximately 35% of cases, the jejunum in 30%, and a combination of large and small intestines in the remaining cases. In most patients who underwent surgery, recovery was uneventful; however, complications occurred in a few cases. We observed cervical diverticula in 5 patients (3.4%; 2 females, 3 males), pleural hernias in 5 patients (3.4%; 2 females, 3 males; all of these patients underwent reoperation), colic tube distension in 5 patients (3.4%; 3 females, 2 males), cervical stenosis in 2 patients (1.4%; 1 female, 1 male), and ulcerations in 2 patients (1.4%; 1 female, 1 male). Additionally, one female patient exhibited a genu-like flexion in the intestinal segment, while two patients (1 female, 1 male) developed ulcerations in the intestinal substitute. Another female patient had a large colic remnant. The best results in restoring the passage between the pharynx and stomach were achieved using jejunal segments, as they provided an identical lumen diameter for anastomosed segments. The experience of the surgical team was a key factor in achieving successful outcomes.
解剖结构是食管重建手术规划和实施过程中的首要因素。当有必要替换因病理原因导致梗阻的天然食管时，例如在摄入腐蚀性物质之后，可以利用胃或肠道构建管道。我们为300多名患者实施了基于肠道的食管损伤和闭锁重建手术。本研究分析了其中1990年至2010年间接受治疗的147例患者（60名女性、70名男性和17名儿童：7名女孩和10名男孩）。决定使用大肠或小肠作为替代物是基于其血供情况，术中会对血供进行评估。重建手术采用带蒂肠段进行，约35%的病例使用结肠，30%使用空肠，其余病例则使用大肠和小肠联合的方式。大多数接受手术的患者恢复顺利；然而，少数病例出现了并发症。我们观察到5例患者（3.4%；2名女性，3名男性）出现颈部憩室，5例患者（3.4%；2名女性，3名男性；所有这些患者均接受了再次手术）出现胸膜疝，5例患者（3.4%；3名女性，2名男性）出现结肠管扩张，2例患者（1.4%；1名女性，1名男性）出现颈部狭窄，2例患者（1.4%；1名女性，1名男性）出现溃疡。此外，1名女性患者的肠段出现类似膝状的弯曲，2例患者（1名女性，1名男性）在肠替代物中出现溃疡。另1名女性患者有一个较大的结肠残端。使用空肠段恢复咽与胃之间通道的效果最佳，因为它们为吻合段提供了相同的管腔直径。手术团队的经验是取得成功结果的关键因素。
