Richard J, Ansiaux J P, Bizeau F, Casaban D, Grébert P, Mounir B, Blonz J M, Mary G, Tranier T
Service de Chirurgie, Hôpital Peltier, Djibouti.
Med Trop (Mars). 1994;54(3):235-8.
Because of delayed diagnosis in Black Africa, esophageal cancer is often seen at an advanced stage when dysphagia is total and eating becomes impossible. At this stage, palliative surgery is the only alternative to enable the patient to eat. Over a 27 month period in Djibouti, palliative therapy for esophageal cancer was indicated in 49 patients and surgery was performed in 37 of these patients. Out of 26 patients to whom gastrostomy was proposed, there were 12 that refused and 14 who underwent the procedure with a mean survival of 40 days. Esophageal bypass was performed in 23 patients. In 22 of these patients, the procedure was colon interposition and in the remaining case a gastric tube was used. There was one postoperative death. Excluding 3 patients that suffered cervical fistulas and one patient who required redo to remove a textiloma, postoperative recovery was uneventful. Patients resumed eating and were able to return home less than one month after the procedure. This study demonstrates that colon interposition can be performed in Black Africa despite limited availability of preoperative and postoperative intensive care facilities. It is a useful alternative for the management of malignant and benign stenosis.
由于在黑非洲地区诊断延迟，食管癌往往在晚期才被发现，此时吞咽困难完全出现，无法进食。在这个阶段，姑息性手术是让患者能够进食的唯一选择。在吉布提的27个月期间，49例食管癌患者需要进行姑息治疗，其中37例接受了手术。在26例被建议进行胃造口术的患者中，12例拒绝，14例接受了该手术，平均生存期为40天。23例患者进行了食管旁路手术。其中22例采用结肠间置术，其余1例使用胃管。有1例术后死亡。排除3例发生颈部瘘管的患者和1例需要再次手术切除纺织瘤的患者，术后恢复顺利。患者术后恢复进食，术后不到一个月就能回家。这项研究表明，尽管术前和术后重症监护设施有限，但在黑非洲地区仍可进行结肠间置术。它是治疗恶性和良性狭窄的一种有用的替代方法。
