Choi R S, Lillehei C W, Lund D P, Healy G B, Buonomo C, Upton J, Hendren W H
Department of Surgery, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
J Pediatr Surg. 1997 Jul;32(7):1083-7; discussion 1087-8. doi: 10.1016/s0022-3468(97)90404-8.
Caustic injury to the upper aerodigestive system with scarring of the pharynx, hypopharynx, and esophagus is a challenging reconstructive problem. The authors report on seven patients who required total esophageal replacement from the pharynx to the stomach. Injury occurred from alkali in six and acid in one. Age at injury ranged from 14 months to 14 years (mean, 4.5 years.) in five boys and two girls. Time from injury to esophageal replacement was 6 months to 10 years (mean, 3.5 years). Two required pharyngeal reconstruction before and one after esophageal replacement. Six patients had an isoperistaltic right or transverse colon interposition. One who had gastric necrosis had an ileo-right colonic substernal interposition with creation of a jejunal reservoir. Results of barium swallows showed intact anastomoses in all patients. There were no leaks. Most had some degree of mild to moderate aspiration, and one who had left vocal cord paralysis had initially massive aspiration. Three patients currently eat regular diets; four eat but still require supplemental tube feeds. The authors conclude that children who have hypopharyngeal scarring and obliterated esophageal inlet can undergo a successful colonic esophageal replacement with high proximal pharyngocolic anastomosis.
上消化道和呼吸道系统的腐蚀性损伤伴咽、下咽和食管瘢痕形成是一个具有挑战性的重建问题。作者报告了7例需要从咽到胃进行全食管置换的患者。6例因碱烧伤，1例因酸烧伤。受伤年龄在14个月至14岁之间（平均4.5岁），其中5例为男孩，2例为女孩。从受伤到食管置换的时间为6个月至10年（平均3.5年）。2例在食管置换前需要进行咽部重建，1例在食管置换后需要进行咽部重建。6例患者采用了顺蠕动的右半结肠或横结肠间置术。1例发生胃坏死的患者采用了胸骨后回肠-右半结肠间置术并建立了空肠贮袋。钡餐检查结果显示所有患者的吻合口均完整。无渗漏。大多数患者有一定程度的轻度至中度误吸，1例左侧声带麻痹患者最初有大量误吸。3例患者目前能正常饮食；4例患者能进食，但仍需要补充管饲。作者得出结论，患有下咽瘢痕形成和食管入口闭塞的儿童可以成功地进行结肠代食管术，并进行高位近端咽结肠吻合。
