回结肠代食管治疗小儿食管良性狭窄  

Ileocolic esophageal replacement in children with benign stricture of esophagus

作　　者：韦福康[1] 胡廷泽[1] 刘铭[2] 向波[1] 罗启成[1] 刘敏[1] 李福玉[1] 

机构地区：[1]华西医科大学附属第一医院小儿外科,四川省成都市610041 [2]四川省泸州医学院附属医院小儿外科,四川省泸州市646100

出　　处：《世界华人消化杂志》2000年第12期1345-1349,共5页World Chinese Journal of Digestology

基　　金：四川省卫生厅科研基金资助课题;No.962017~~

摘　　要：目的采用附有回盲瓣的回结肠肠段替代食管术治疗小儿食管化学灼伤性狭窄,并对该术式的应用解剖研究和术后早期对代谢的影响作出评价.方法 1992/1999采用顺蠕动回结肠肠段经胸骨后途径替代食管术式共12例,另以50具尸体观察、测量回结肠肠段的血管配布状况及20只仔猪的动物模型检测手术前后与手术组及对照组问的代谢指标的变化.结果临床12例获平均3a 随访,无手术死亡,2例发生颈部吻合口瘘;回结肠肠段的静脉配布较动脉恒定,动脉配布分7个类型,边缘动脉未见吻合中断;整段切除仔猪50cm 末端回肠、盲肠和50cm 的升结肠后,短期内影响胆汁酸(胆盐)的肠-肝循环,进而可影响脂肪代谢;因缩短了水分在肠道内吸收的时间和面积,引起粪便变稀以及失去回盲瓣的"细菌栅栏"作用导致结肠内细菌迁入回肠并大量繁殖.结论利用回盲瓣的抗反流功能施行回结肠代食管术临床已获满意疗效,掌握回结肠肠段的血管配布特点和手术后对代谢的影响将有助于指导手术操作和术后处理,减少术后并发症的发生.AIM To assess applied anatomy research of the operative technique and influences upon metabolism in early period after operation in the article.Using ileocolon with ileocecal valve as a substitute for esophagus treated esophageal stricture secondary to the ingestion of corrosive materials in children. METHODS Between 1992 and 1999,isoperistaltic retrosternal ileocolic esophageal replacements were performed in 12 patients;the vascularity in the ileocolic region was observed in 50 cadavers;metabolic indexes were measured before and after surgery or between the operative group and the normal controls in 20 piglet models. RESULTS The mean time of follow-up was 3 years in the 12 cases and no death occurred in intra- and post- operative period clinically.Cervical ileoesophageal anastomotic leaks took place in 2 cases.The distribution pattern of venous vessel in the ileocolic region was far more constant than that of artery.The arrangements of artery in the ileocolic segment were classified into 7 types,and there was no interruption of paracolic anastomosis between arteries.The resections of 50 cm terminal ileum,cecum and 50cm ascending colon influenced enterohepatic circulation of bile acid(bile salt) and affected fat metabolism in early period after surgery in piglet models.Shortening the time and reducing the area for water absorption after ileocolic resection resulted in diarrhea in piglet models.The loss of'bacterial barrier'role of ileocecal valve led to bacteria immigration from colon to ileum and small intestinal bacterial overgrowth. CONCLUSION The ileocolic esophageal replacement using antireflux role of the ileocecal valve has satisfactory effect.To understand the characteristics of the patterns of arteries and veins distribution and physiological functions of the ileocolic segment may be useful in guiding clinical practice and postoperative management and preventing postoperative complications.

关 键 词：食管狭窄 治疗 回盲瓣 回结肠食管替代 

分 类 号：R726.5[医药卫生—儿科]