结肠代食管手术68例临床分析  

Colon interposition for esophageal replacement: 68 cases analysis

作　　者：蒋俭[1] 李建业[1] 于涛[1] 于磊[1] 杨磊[1] 魏博[1] 

机构地区：[1]首都医科大学附属北京同仁医院胸外科,100730

出　　处：《北京医学》2006年第5期273-275,共3页Beijing Medical Journal

摘　　要：目的探讨结肠代食管手术在胸外科中的应用。方法选择我院1984年6月至2003年6月行结肠代食管手术患者68例,分为良性疾病组37例和恶性疾病组31例。68例均经胸骨后途径行结肠代食管术。结果本组无手术死亡者。术后出现移植结肠坏死2例,吻合口瘘9例,吻合口狭窄2例,左喉返神经损伤3例。良性疾病组随访32例,随访1～12年,临床效果:1级22例,2级8例,3级1例,4级1例。恶性疾病组术后随访率为90.3%,3年、5年生存率分别为57.8%、31.4%。结论结肠代食管术是较为理想的食管重建术,可适当放宽适应证,移植肠段的选择应由肠管血运决定。Objective To evaluate the value of colon interposition for esophageal replacement in thoracic surgery. Methods 68 patients who had undergone colon interposition for esophageal replacement were studied retrospectively. In the benign disease group, there were 30 cases of corrosive esophagitis, 5 cases of esophageal perforation 2 cases of congenital esophageal stricture, whereas there were 31 cases of esophageal carcinoma and cardiac cancer （malignant disease group）, in the malignant disease group upper esophageal cancer for 25 cases, middle and lower esophageal cancer for 5 cases who had undergone gastrectomy in the past anastomotic stoma recurrence after gastric cardia cancer resection for 1 case. The interposition colon for all patients were through substernum paths. Results There was no mortality during the hospital stay, but 2 cases had total colon necrosis, 9 cases had anastomotic stoma fistula and 3 cases had recurrent laryngeal nerve injury. 32 patients in the benign disease group were followed. 22 cases, 8 cases, 1 cases and 1 cases were evalluated as grade 1 （extremely satisfied）, grade 2 （very satisfied）, grade 3 （satisfied） and grade 4 （unsatisfied） respectively. For the malignant disease group, the 3- year and 5- year survival rate was 57.8% ,31.4% respectively. Conclusions Colon interposition after esophagectomy is an ideal surgical treatment for esophageal reconstruction. Its indications should be expanded properly. The choice of the graft colon mainly depends on its blood supply.

关 键 词：结肠代食管术 食管腐蚀性狭窄 食管癌 

分 类 号：R655.4[医药卫生—外科学]