Hester T R, McConnel F, Nahai F, Cunningham S J, Jurkiewicz M J
Ann Surg. 1984 Jun;199(6):762-9. doi: 10.1097/00000658-198406000-00015.
Fifty-five patients with disorders of the pharynx or cervical esophagus requiring extensive ablative therapy were reconstructed by heterotopic autotransplantation of a segment of jejunum. Of these 55 patients, the overwhelming majority were treated for squamous cell carcinoma or the complications of combined radiation and operative therapy. There were six graft failures in the entire group of 55 patients for a transfer reliability of 90%. Three patients died in the perioperative period (5%). The purpose of this paper is to report on the treatment of a subset of these patients in whom fixed cicatricial stenosis of the gullet was the problem or in whom a radionecrotic cutaneous fistula existed. Fourteen such patients were treated, ten with stricture and four with fistula. Both patch grafts of on-lay segments and more routine circumferentially intact tubed segments of jejunum were used depending upon the nature of the defect. The youngest patient in this group was a 3-year-old juvenile diabetic with caustic stricture and the oldest was a 75-year-old man with fixed stricture following operation and radiation for cancer. Nine of ten and four of four anatomic reconstructions were successful in the stricture and fistula patients, respectively. All of these 13 patients with a neo- gullet of jejunum were able to handle secretions and liquids satisfactorily. Eleven patients were on a regular diet and had no discernible physiological impairment in alimentation. One patient had mild dysphagia and used a blenderized diet. One patient was able to swallow liquids only. In this patient the resection for tumor was so high and so extensive that the physiologic act of deglutition itself was impaired. There were no perioperative deaths, although one patient has succumbed to recurrent and metastatic carcinoma. When conventional treatment for stricture or fistula in the cervical alimentary tract has failed, reconstruction can be accomplished safely by free revascularized jejunal graft. Successful alimentation can be anticipated in all patients in whom the physiologic mechanism of deglutition itself is not drastically impaired.
55例患有咽或颈段食管疾病且需要广泛切除治疗的患者，通过空肠段异位自体移植进行了重建。在这55例患者中，绝大多数接受的是鳞状细胞癌或放疗与手术联合治疗的并发症的治疗。55例患者中共有6例移植失败，移植成功率为90%。3例患者在围手术期死亡（5%）。本文的目的是报告对这些患者中的一部分患者的治疗情况，这些患者存在食管固定性瘢痕狭窄问题或存在放射性坏死性皮肤瘘。治疗了14例这样的患者，其中10例为狭窄患者，4例为瘘患者。根据缺损的性质，既使用了补片移植的外置空肠段，也使用了更常规的完整环形带蒂空肠段。该组中最年轻的患者是一名3岁的患有腐蚀性狭窄的青少年糖尿病患者，最年长的是一名75岁的男性，因癌症接受手术和放疗后出现固定性狭窄。10例狭窄患者中有9例、4例瘘患者中有4例的解剖重建成功。这13例拥有空肠新食管的患者均能令人满意地处理分泌物和液体。11例患者能够正常饮食，在营养方面没有明显的生理损害。1例患者有轻度吞咽困难，采用搅拌食物的饮食方式。1例患者仅能吞咽液体。在该患者中，肿瘤切除范围过高且过大，以至于吞咽的生理动作本身受到了损害。尽管有1例患者死于复发和转移性癌，但围手术期无死亡病例。当颈部消化道狭窄或瘘的常规治疗失败时，可通过游离血管化空肠移植安全地完成重建。对于吞咽生理机制本身未受到严重损害的所有患者，均可预期实现成功的营养摄入。
