Fujiwara K, Higashino M, Osugi H, Tokuhara T, Kaseno S, Kinoshita H
Second Department of Surgery, Osaka City University Medical School, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Dec;43(12):1948-52.
Recently, with increase of number of esophagectomy for esophageal cancer, the cases having the lesion in the organs for esophageal substitute have been increasing. The case of esophageal cancer, required reconstruction using the pedicled jejunum, because of impaired submucosal blood perfusion of the stomach caused by a ulcer scar, was reported. The patient was a 72-year-old female, with the ulcerative and infiltrative cancer lesion in the anterior wall of the mid-thoracic esophagus. Barium swallow revealed shortening of the lesser curvature and indentation of the greater curvature of the stomach. Endoscopy showed the lesion occupying anterior two thirds of the esophageal wall circumferentialy from 30 to 34 cm from the incisor tooth. The lineal scar of ulcer on the lesser curvature of the body of the stomach was also found. Following esophagectomy through right thoracotomy, the stomach was mobilized for reconstruction by dividing left gastric artery and short gastric artery, but the stomach oral to the ulcer scar became ischemic and bleeding was not found at the tip of the stomach. Therefore, reconstruction was performed using the pedicled jejunum through antesternal route. The gastric cardia is rich in the vascular network in the submucosal layer. The ulcer or ulcer scar of this region can cause ischemia in the tip of the gastric tube for esophageal substitute. Care should be taken to detect the ulcer lesion at the stomach preoperatively. In the case with the ulcer lesion blood supply to the tip of the gastric tube should be critically evaluated.
近年来，随着食管癌切除术数量的增加，食管替代器官出现病变的病例也在增多。有报道称，一名食管癌患者因溃疡瘢痕导致胃黏膜下血液灌注受损，需要用带蒂空肠进行重建。患者为72岁女性，胸段食管中段前壁有溃疡性浸润性癌灶。吞钡检查显示胃小弯缩短，大弯有压迹。内镜检查显示病变从距门牙30至34厘米处环形占据食管壁的前三分之二。还发现胃体小弯处有溃疡的线性瘢痕。经右胸切口行食管切除术后，通过切断左胃动脉和胃短动脉游离胃以进行重建，但溃疡瘢痕上方的胃出现缺血，胃尖未发现出血。因此，通过胸骨前途径用带蒂空肠进行重建。胃贲门黏膜下层血管网丰富。该区域的溃疡或溃疡瘢痕可导致用于食管替代的胃管尖端缺血。术前应注意检测胃的溃疡病变。对于有溃疡病变的病例，应严格评估胃管尖端的血供。
