Mansour K A, Bryan F C, Carlson G W
Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Ann Thorac Surg. 1997 Sep;64(3):752-6. doi: 10.1016/s0003-4975(97)00616-4.
From 1972 to 1996, bowel interposition reconstruction after esophagectomy for benign and malignant conditions was performed in 129 of 131 patients. The indication for operation was benign disease in 94 patients (72.9%) and malignant disease in 35 patients (27.1%). Benign stricture was the most common presentation in the benign group (41 patients), and adenocarcinoma was the most common indication in the malignant group (19 patients).
One hundred thirty-three conduits were performed in the 129 patients. Four patients (3.1%) required reoperative reconstruction. Of the 97 conduits employed for reconstruction of benign disease, the right colon was used in 70 patients, the left colon in 9 patients, and the transverse colon in 4 patients. A jejunal interposition graft was employed in 11 patients and a free jejunal autograft in 3 patients. The right colon was used in 15 patients with malignant disease, the left colon in 9 patients, and the jejunum in 12 patients.
The mean age of the population was 54.5 years (range, 14 to 72 years) with a male-to-female ratio of 1.3:1. The average number of prior thoracic or abdominal procedures was 2.9 (range, 1 to 8) with 50.9% of patients undergoing reoperation. The mean length of stay was 21.7 days (range, 8 to 290 days). Complications occurred in 37.1% of patients with anastomotic leak occurring in 14.8% and ischemic colitis in 3.0% of conduits performed. The in-hospital mortality was 5.9%.
Bowel interposition reconstruction after esophagectomy for benign and malignant disease can be performed with an acceptable morbidity and mortality, despite prior operative procedures in the abdomen or chest. Colonic and jejunal conduits, employed alone or in combination, can effectively restore gastrointestinal continuity.
1972年至1996年期间，131例患者中有129例在食管切除术后进行了肠代食管重建术，用于治疗良性和恶性疾病。手术适应证为良性疾病94例（72.9%），恶性疾病35例（27.1%）。良性狭窄是良性组最常见的表现（41例），腺癌是恶性组最常见的适应证（19例）。
129例患者共进行了133次肠代食管重建术。4例（3.1%）患者需要再次手术重建。在用于良性疾病重建的97次肠代食管术中，70例患者使用了右结肠，9例使用了左结肠，4例使用了横结肠。11例患者采用空肠间置移植，3例采用游离空肠自体移植。15例恶性疾病患者使用了右结肠，9例使用了左结肠，12例使用了空肠。
患者的平均年龄为54.5岁（范围14至72岁），男女比例为1.3:1。既往胸部或腹部手术的平均次数为2.9次（范围1至8次），50.9%的患者接受了再次手术。平均住院时间为21.7天（范围8至290天）。37.1%的患者发生并发症，14.8%的患者发生吻合口漏，3.0%的肠代食管术发生缺血性结肠炎。住院死亡率为5.9%。
食管切除术后用于良性和恶性疾病的肠代食管重建术，尽管患者既往有腹部或胸部手术史，但仍可在可接受的发病率和死亡率下进行。单独或联合使用结肠和空肠代食管可有效恢复胃肠道连续性。
