Thomas P, Fuentes P, Giudicelli R, Reboud E
Department of Thoracic Surgery, University of Marseille, France.
Ann Thorac Surg. 1997 Sep;64(3):757-64. doi: 10.1016/s0003-4975(97)00678-4.
In contrast to the use of the stomach as an esophageal substitute, the use of the colon is becoming uncommon.
From 1985 to 1995, 60 patients underwent colon interposition for esophageal cancer (n = 37), benign stricture (n = 13), iatrogenic fistula (n = 5), achalasia (n = 3), or necrosis of a previous substitute (n = 2). A long isoperistaltic conduit based on the left colonic artery could be used in 52 patients (86.7%). The surgical route used was through the esophageal bed in 38 patients (63.3%), under the sternum in 21 patients, and under the skin in 1 patient.
Colon interposition represented 18.5% of all operations performed for esophageal substitution during the study period. The choice of the colon resulted from an inadequate stomach in 33 cases (55%). The operative mortality rate was 8.3%. Seven patients (13.5%) required dilation of the esophagocolonic anastomosis. At last follow-up, 34 patients (65.4%) had no difficulty eating. Multivariate analysis identified the conduit position in the posterior mediastinum as the sole independent predictor of a good functional result (p = 0.002).
Colon interposition for esophageal substitution, usually performed when the stomach is not available, provides satisfactory function when placed in the esophageal bed.
与使用胃作为食管替代物相比，使用结肠作为替代物的情况正变得不常见。
1985年至1995年期间，60例患者接受了结肠代食管手术，其中食管癌患者37例，良性狭窄患者13例，医源性瘘患者5例，贲门失弛缓症患者3例，既往替代物坏死患者2例。52例患者（86.7%）可使用基于左结肠动脉的长顺蠕动管道。手术路径方面，38例患者（63.3%）经食管床进行，21例患者经胸骨后进行，1例患者经皮下进行。
在研究期间，结肠代食管手术占所有食管替代手术的18.5%。33例患者（55%）因胃不适用而选择结肠。手术死亡率为8.3%。7例患者（13.5%）需要对食管结肠吻合口进行扩张。在最后一次随访时，34例患者（65.4%）进食无困难。多因素分析确定后纵隔内管道位置是功能良好结果的唯一独立预测因素（p = 0.002）。
结肠代食管手术通常在无法使用胃时进行，当置于食管床时可提供令人满意的功能。
