Inoue Y, Tai Y, Fujita H, Tanaka S, Migita H, Kiyokawa K, Hirano M, Kakegawa T
Department of Plastic and Reconstructive Surgery, Kurume University School of Medicine, Japan.
Plast Reconstr Surg. 1994 Aug;94(2):277-84; discussion 285-7.
We have studied 66 patients who underwent esophageal reconstruction using microvascular anastomoses. This series comprises 28 patients with reconstruction using a free jejunal interposition between the pharynx and the cervical esophagus following pharyngolaryngoesophagectomy for hypopharyngeal carcinoma and 38 atypical patients in whom other methods of reconstruction were used. Successful transfer was achieved in 98.5 percent (65 of 66). Issues concerning atypical reconstruction and our procedures in these cases are discussed. In order to obtain adequate tension in the jejunum on the anal side, in particular, since the anastomosis is located in a deep or narrow space, autosuture instruments were used. The anastomotic leakage rate was 2.8 percent (1 of 36); the stenosis rate was 2.8 percent (1 of 36). To prevent necrosis in the trachea, a greater omentum flap was used in three patients, a mesenterium flap in two, and a pectoralis major musculocutaneous flap in one. There were no significant complications. In patients with a short gastric pedicle or in those in whom a double cancer occurred in the hypopharynx and thoracic esophagus, a gastric pedicle and a free jejunum flap were used together. As a result of this method, the incidence of any reflux of digestive juice was reduced to 0 percent (0 of 6). To reduce the possibility of an ischemic complication at the oral end of the colonic pedicle, we added a microvascular anastomosis of the colonic pedicle, thereby reducing both leakage [0 percent (0 of 9)] and necrosis [0 percent (0 of 9)]. These procedures involving microvascular anastomoses have reduced the incidence of complications in esophageal reconstructions.
我们研究了66例接受微血管吻合进行食管重建的患者。该系列包括28例在下咽癌行下咽、喉、食管切除术后，采用游离空肠在咽与颈段食管之间进行重建的患者，以及38例采用其他重建方法的非典型患者。98.5%（66例中的65例）实现了成功移植。讨论了非典型重建的相关问题以及我们在这些病例中的手术方法。特别是为了在空肠的肛门侧获得足够的张力，由于吻合口位于深部或狭窄空间，使用了自动缝合器械。吻合口漏率为2.8%（36例中的1例）；狭窄率为2.8%（36例中的1例）。为防止气管坏死，3例患者使用了大网膜瓣，2例使用了肠系膜瓣，1例使用了胸大肌肌皮瓣。无明显并发症。对于胃蒂短的患者或下咽和胸段食管发生双癌的患者，同时使用胃蒂和游离空肠瓣。采用这种方法后，消化液反流的发生率降至0%（6例中的0例）。为降低结肠蒂口腔端缺血并发症的可能性，我们增加了结肠蒂的微血管吻合，从而降低了漏率[0%（9例中的0例）]和坏死率[0%（9例中的0例）]。这些涉及微血管吻合的手术方法降低了食管重建中并发症的发生率。
