Zacherl J, Wild K, Ockher M, Glaser C, Rath T, Millesi W, Wenzl E
Universitätsklinik für Chirurgie, Wien.
Langenbecks Arch Chir. 1997;382(1):55-8. doi: 10.1007/BF02539310.
Reconstruction after radical tumor resection in the oropharyngeal region still represents an interdisciplinary challenge. Autotransplantation of the jejunum is a popular procedure, in which the abdominal surgeon's main task is that of harvesting enteral tissue. To evaluate this technique, a careful analysis of accompanying perioperative abdominal complications was performed. Additionally, we reexamined 35 of 66 patients still living after a follow-up period of 21 (range 2-63) months on average. The perioperative mortality of 90 patients treated for oropharyngeal malignancy using the described procedure was 7.8%. None of the perioperative deaths was caused by an abdominal complication associated with enteral resection. One abdominal reoperation was performed because of abdominal wall dehiscence. For reasons not related to enteral resection, four further patients had to be relaparotomized, two of them during their hospital stay and two after leaving hospital. In five cases we observed minor complications which could be treated nonsurgically. In the follow-up reexamination we detected no abdominal late-onset complication except small incisional hernias in six cases. Finally, we concluded that despite an elevated overall operative risk in this population, complications owing to jejunal resection were comparably low. The data regarding the rate of complications classify jejunal resection as a safe procedure for reconstructive purposes in patients suffering from oropharyngeal malignancy.
口咽区域肿瘤根治性切除术后的重建仍然是一项跨学科的挑战。空肠自体移植是一种常用的手术方法,腹部外科医生的主要任务是获取肠组织。为了评估该技术,我们对围手术期伴随的腹部并发症进行了仔细分析。此外,我们对平均随访21个月(范围2 - 63个月)后仍存活的66例患者中的35例进行了复查。采用上述方法治疗口咽恶性肿瘤的90例患者围手术期死亡率为7.8%。围手术期死亡均非由肠切除相关的腹部并发症所致。因腹壁裂开进行了1次腹部再次手术。另有4例患者因与肠切除无关的原因接受了再次剖腹手术,其中2例在住院期间,2例在出院后。有5例出现了可通过非手术治疗的轻微并发症。在随访复查中,除6例出现小切口疝外,未发现腹部迟发性并发症。最后,我们得出结论,尽管该人群总体手术风险较高,但空肠切除引起的并发症相对较低。关于并发症发生率的数据表明,空肠切除对于口咽恶性肿瘤患者的重建而言是一种安全的手术方法。