Hirabayashi S, Miyata M, Shoji M, Shibusawa H
Department of Surgery, Jichi Medical School, Tochigi, Japan.
Surgery. 1993 May;113(5):515-9.
After radical ablation of tumors, colon or jejunum is pulled up for reconstruction of the thoracic esophagus when stomach is unusable. However, esophagocolonic or esophagojejunal anastomotic leak is relatively frequent because of the potential for vascular insufficiency of conduit extended upward.
To overcome this disadvantage, 14 consecutive patients with esophageal or gastric carcinomas whose stomachs were unusable were subjected to thoracoesophageal reconstruction through upward extension of the jejunum with microvascular anastomosis. Jejunal vessels were used as graft vessels, and internal thoracic vessels were used as recipient vessels. If needed, arcade vessels were severed to ease extension.
All extended jejunums survived, and there were no operative deaths. Two of four initial series of patients, whose arcade vessels were not severed despite undue tension at the anastomotic site, had esophagojejunal anastomotic leaks that healed spontaneously.
Some clinical functional problems still exist, but we believe this a safe and useful method for reconstruction of the esophagus where stomach cannot be used.
肿瘤根治性切除术后，当胃无法使用时，可将结肠或空肠上提用于重建胸段食管。然而，由于上提的管道存在血管供血不足的可能性，食管结肠或食管空肠吻合口漏相对较为常见。
为克服这一缺点，对14例连续的食管癌或胃癌患者（其胃无法使用）通过空肠上提并进行微血管吻合术来进行胸段食管重建。空肠血管用作移植血管，胸廓内血管用作受体血管。如有必要，切断弓状血管以利于上提。
所有上提的空肠均存活，无手术死亡病例。在最初的4例患者中，有2例尽管吻合口处张力过大但未切断弓状血管，发生了食管空肠吻合口漏，不过均自行愈合。
虽然仍存在一些临床功能问题，但我们认为这是一种在胃无法使用时安全且有用的食管重建方法。
