Reece G P, Schusterman M A, Miller M J, Kroll S S, Robb G L, Baldwin B J, Luethcke D R
Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, USA.
Plast Reconstr Surg. 1995 Nov;96(6):1307-16. doi: 10.1097/00006534-199511000-00012.
Free jejunal transfer has been criticized by some surgeons as unreliable, poorly tolerant of radiation therapy, and associated with significant morbidity and dysphagia. To determine the validity of these criticisms, we reviewed 93 patients who underwent 96 free jejunal transfers for repair of circumferential pharyngoesophageal defects over a 5-year period. The free jejunal transfer success rate was 97 percent; all 3 failures were repaired with repeated free jejunal transfer. The complication rate was 57 percent (55 of 96); fistula (19 percent) and stricture (15 percent) were the most common complications. An oral diet was tolerated by 80 percent of patients; 85 percent of these resumed their diet within 2 weeks of surgery. Causes of dysphagia were multifactorial. Postoperative radiation therapy did not increase morbidity or dysphagia. The perioperative mortality rate was 2 percent. We conclude that free jejunal transfer is a reliable method of pharyngoesophageal reconstruction that has an acceptable morbidity rate and a low mortality rate. Postoperative radiation therapy is well tolerated by the free jejunal transfer.
游离空肠移植术被一些外科医生批评为不可靠、对放射治疗耐受性差，且伴有严重的并发症和吞咽困难。为了确定这些批评的真实性，我们回顾了93例患者，他们在5年期间接受了96次游离空肠移植术以修复环周性咽食管缺损。游离空肠移植术的成功率为97%；所有3例失败均通过再次游离空肠移植术修复。并发症发生率为57%（96例中的55例）；瘘（19%）和狭窄（15%）是最常见的并发症。80%的患者能够耐受经口饮食；其中85%的患者在术后2周内恢复饮食。吞咽困难的原因是多因素的。术后放射治疗并未增加并发症发生率或吞咽困难的发生率。围手术期死亡率为2%。我们得出结论，游离空肠移植术是一种可靠的咽食管重建方法，其并发症发生率可接受且死亡率低。游离空肠移植术对术后放射治疗耐受性良好。
