食管化学性灼伤后狭窄的手术与并发症治疗  

Surgical Treatment of the Esophageal Stricture Caused by Chemical Burn and Management of Postoperative Complications

作　　者：孙耀昌[1] 答作为[1] 徐志飞[1] 李建秋[1] 万国泰[1] 

机构地区：[1]第二军医大学附属长征医院胸心外科,上海200003

出　　处：《中华创伤杂志》1996年第5期312-314,共3页Chinese Journal of Trauma

摘　　要：目的:手术治疗食管化学性灼伤后狭窄。方法:重建食管的手术方式包括间置结肠代食管术20例,胃代食管术2例,游离空肠移植代食管术7例,空肠部分带蒂加近端小血管吻合移植代食管术6例。结果:全组无手术死亡。间置结肠代食管术的并发症有颈部吻合口瘘4例,吻合口狭窄1例,颈部切口感染3例,粘连性肠梗阻2例,间置结肠蛔虫性穿孔致脓胸1例。空肠移植代食管术后有4例发生肠咽吻合口并发症,其中3例行肠咽吻合成形术恢复了患者的吞咽及语言功能,1例因喉部损伤严重,肠咽吻合口再狭窄反复发生吸入性肺炎,行喉气管—移植空肠吻合重建了食管通道。结论:间置结肠代食管术是治疗食管化学性灼伤后狭窄有效的外科治疗方法,空肠移植代食管术是治疗高位食管化学性灼伤后狭窄的首选方法。Aim:To explore operation for esophageal stricture caused by chemical burns and management of postop- erative complications.Methods:Operations for esophageal reconstruction,including colon interposition graft in 20 cas- es,gastric substitute in 2 cases,free jejunal graft in 7 cases,jejunal graft with partial pedicle and small vascular anasto- mosis at the end of the jejunum in 6 cases,were performed.Results:No operative death occourred.Complications of colon interposition included fistula of cervical anastomosis in 4 cases,stenosis of cervical anastomosis in 1,cervical inci- sion infection in 3 and adhesive intestinal obstruction in 2.One case had empyema caused by perforation of ascariasis in interposed colon.Four cases had complications of jejunopharyngeal anastomosis after the jejunal graft.Three of the 4 were treated by the modified jejunopharyngostomy and recovered their swallowing and speaking functions,and one had aspirative pneumonia caused by severe impairment of larynx and stenosis of the jejunopharyngostomy.Reconstruction of food conduit of the patient was performed successfully by laryngotrachea-grafted jejunum anastomosis.Conclusion: Colon interposition graft is an effective surgical treatment for esophageal stricture caused by chemical burn.Jejunal graft is the first choise for high position stricture of esophagus caused by chemical burn.

关 键 词：食管 烧伤 并发症 外科手术 

分 类 号：R655.406[医药卫生—外科学] R644.05[医药卫生—临床医学]