食管腐蚀性烧伤后严重狭窄的外科治疗  

Surgical treatment of esophageal reconstruction for severe caustic esophageal stricture

作　　者：乌立晖[1] 徐志飞[1] 赵学维[1] 李建秋[1] 孙光远[1] 彭昊[1] 孙耀昌[1] 

机构地区：[1]第二军医大学长征医院胸心外科,上海200003

出　　处：《临床外科杂志》2011年第6期408-410,共3页Journal of Clinical Surgery

摘　　要：目的探讨食管腐蚀性烧伤后狭窄的外科治疗经验及胃或横结肠代食管重建手术的应用价值。方法对98例食管腐蚀性烧伤后狭窄的患者中72例广泛食管狭窄、病变超过食管中段以上者采用横结肠代食管、保留结肠左动脉升支、胸骨后顺蠕动吻合，其中横结肠咽腔吻合18例，横结肠食管颈部吻合54例，胸段食管旷置不切除；26例狭窄位于中下段，经胸切除瘢痕段食管用胃重建食管，胃食管胸内吻合。结果结肠食管重建72例中，术后死亡4例（5．56％），发生颈部吻合口瘘14例（19．44％），后期出现颈部吻合口狭窄7例，经治疗后均痊愈。胃重建食管26例无手术死亡，术后发生胸内吻合口狭窄3例，经扩张治愈。结论食管腐蚀性烧伤后狭窄在伤后20～24周可积极采取食管重建术，根据食管狭窄段严重程度及位置决定是否行狭窄段食管切除、选择食管重建替代物及吻合的位置。可采用横结肠食管颈部吻合或结肠咽腔吻合术，胸内胃食管吻合术。Objective To review the experience of surgical management for caustic esophageal stricture and discuss the surgical techniques of stomach or transverse colon interposition for esophageal replacement. Method Among 98 patients with caustic esophageal stricture, 72 patients with extensive esophageal stricture, esophageal lesions higher than middle piece ,were reconstructed esophageal with transverse colon,iso - peristaltic anastomosis retrosternal. Their ascending branch of the left artery of the transverse colon was preserved as the supporting vessel of the interpositioned colon（ 18 cases of transverse colon pharyngeal anastomosis ,54 cases of transverse colon cervical esophagus anastomosis） ;The thoracic esophagus was not removed）. Other 26 patients with stenosis in the middle and inferior segment esophageal underwent resection of scarring esophagus through thorax, esophagus reconstruction with stomach and intrathoracic esophagogastric anastomosis. Results For esophageal reconstruction with colon in 72 cases,4 patients died after operation（5.56% ）. Cervical anastomotic leakage occurred in 14 cases（ 19.44% ） ,and late neck anastomotic stricture occurred in 7 cases; All these were cured after treatment. In 26 cases of gastric esophageal reconstruction, there was no operative mortality, but postoperative intrathoracic anastomotic stricture in 3 cases,which were subsequently cured by the expansion. Conclusion Corrosive esophageal burn strictures of 20 - 24 weeks after the injury may take active esophageal reconstruction. According to the severity and location of esophageal stenosis, clinicians can determine whether to perform the narrow esophageal resection,choose esophageal reconstruction ahematives and select the location of anastomosis. Available approaches include transverse colon cervical esophagus anastomosis, colon pharynx anastomosis and intrathoracic gastroesophageal anastomosis.

关 键 词：食管狭窄 腐蚀性烧伤 外科治疗 

分 类 号：R655.4[医药卫生—外科学]