Peters J H, Kronson J W, Katz M, DeMeester T R
Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Arch Surg. 1995 Aug;130(8):858-62; discussion 862-3. doi: 10.1001/archsurg.1995.01430080060009.
Little has been written regarding the arterial anatomy predictive of success following esophagectomy and colon interposition.
Retrospective review.
University teaching hospital.
Twenty-five patients undergoing planned left colon interposition.
Colon interposition was performed via an isoperistaltic left colon graft based on the ascending branch of the left colic artery.
Five angiographic features were considered important to successful use of the left colon: (1) a patient inferior mesenteric artery, (2) a visible ascending branch of the left colic artery, (3) a well-defined anastomosis between the middle colic and left colic systems, (4) a single middle colic trunk prior to its division into right and left branches, and (5) a separate origin of the right colic artery. Venous drainage via a patent marginal vein, inferior mesenteric vein, and superior hemorrhoidal veins was preserved in all patients.
Left colon interposition could be performed in 21 (84%) of 25 patients. Eighty percent of the patients (20/25) had at least four of the five criteria thought necessary for optimal graft perfusion. Three or fewer criteria were present in five patients, three of whom underwent gastric interposition. The inferior mesenteric artery was patent in all patients except one who required a right colon interposition. Ninety-two percent (23/25) demonstrated an adequate ascending left colic artery. The superior-inferior mesenteric artery anastomosis was seen in 52% (13/25). A single-trunked middle colic artery was present 80% (20/25) of the time. A single incidence of graft necrosis occurred secondary to venous insufficiency. Ninety-six percent of patients (24/25) were able to swallow without difficulty at the time of discharge from the hospital.
Replacement of the esophagus with colon can be successful in over 80% of patients screened by angiographic criteria. Patients with an occluded or stenotic inferior mesenteric artery or variant middle colic arterial anatomy should undergo an alternate reconstruction.
关于食管癌切除及结肠代食管术后成功的动脉解剖学相关内容鲜有报道。
回顾性研究。
大学教学医院。
25例行计划性左结肠代食管术的患者。
基于左结肠动脉升支，通过顺蠕动左结肠移植行结肠代食管术。
认为对成功使用左结肠至关重要的5项血管造影特征：（1）患者肠系膜下动脉；（2）可见的左结肠动脉升支；（3）中结肠与左结肠系统之间明确的吻合；（4）中结肠干在分为右支和左支之前为单干；（5）右结肠动脉单独起源。所有患者均保留通过通畅的边缘静脉、肠系膜下静脉及痔上静脉的静脉引流。
25例患者中有21例（84%）成功行左结肠代食管术。80%的患者（20/25）具备5项最佳移植物灌注所需标准中的至少4项。5例患者存在3项或更少标准，其中3例接受了胃代食管术。除1例需要右结肠代食管术的患者外，所有患者的肠系膜下动脉均通畅。92%（23/25）的患者显示左结肠动脉升支充足。52%（13/25）的患者可见肠系膜上下动脉吻合。80%（20/25）的时间可见单干中结肠动脉。1例移植物坏死继发于静脉功能不全。96%的患者（24/25）出院时吞咽无困难。
通过血管造影标准筛选的患者中，超过80%的患者行结肠代食管术可成功。肠系膜下动脉闭塞或狭窄或中结肠动脉解剖变异的患者应行替代重建术。
