Urayama H, Ohtake H, Ohmura K, Watanabe Y
First Department of Surgery, Kanazawa University School of Medicine, Japan.
J Thorac Cardiovasc Surg. 1997 Jun;113(6):975-81. doi: 10.1016/S0022-5223(97)70281-2.
Vascular surgical techniques have contributed to the success of pharyngoesophageal reconstruction. We report our methods and analysis of postoperative complications, quality of life, and long-term prognosis.
Sixty-seven patients who underwent pharyngoesophageal reconstruction with use of vascular anastomoses comprised the study population. The operative procedures performed were free jejunal autograft transplantation in 54 patients, gastric pedicle placement with vascular anastomoses in 2, jejunal pedicle with vascular anastomoses in 4, colonic pedicle with vascular anastomoses in 4, free jejunal graft and gastric pedicle in 2, and free jejunal graft and jejunal pedicle in 1. The common carotid artery and internal jugular vein were primarily used as the recipient vessels. The period of postoperative observation ranged from 3 days to 145 months.
The postoperative complications noted were dehiscence in 7 patients, graft failure in 1, wound infection in 2, small bowel intussusception in 4, pneumonia in 2, disseminated intravascular coagulation in 1, and pancytopenia in 1. Revascularization was successful in all but 1 patient, and oral intake was achieved in 58. Persistent swallowing dysfunction was recognized in 4%. Speech restoration was achieved in 57% of the patients with esophageal speech in 7% and with an artificial larynx in 50%. In the long-term follow-up, 36% of our patients died of the primary disease, 9% died of other diseases, and 55% are alive.
Esophageal reconstruction with the use of vascular anastomoses affords low morbidity and mortality. Postoperative swallowing and speech are satisfactory, and the function of the reconstructed esophagus is well preserved for as long as 10 years.
血管外科技术推动了咽食管重建术的成功。我们报告我们的方法以及对术后并发症、生活质量和长期预后的分析。
67例行血管吻合咽食管重建术的患者构成研究人群。所施行的手术操作包括54例游离空肠自体移植术、2例带血管吻合的胃蒂植入术、4例带血管吻合的空肠蒂植入术、4例带血管吻合的结肠蒂植入术、2例游离空肠移植联合胃蒂植入术以及1例游离空肠移植联合空肠蒂植入术。主要采用颈总动脉和颈内静脉作为受区血管。术后观察期为3天至145个月。
观察到的术后并发症包括7例裂开、1例移植失败、2例伤口感染、4例小肠套叠、2例肺炎、1例弥散性血管内凝血和1例全血细胞减少。除1例患者外，所有患者血管再通均成功，58例患者实现经口进食。4%的患者存在持续吞咽功能障碍。57%的患者实现言语恢复，其中7%采用食管言语恢复，50%采用人工喉恢复。在长期随访中，36%的患者死于原发病，9%死于其他疾病，55%存活。
采用血管吻合的食管重建术具有较低的发病率和死亡率。术后吞咽和言语情况令人满意，重建食管的功能可良好保留长达10年。
