分期手术策略在结肠代食管术中的应用分析  

Application of staging strategy in esophageal replacement with colon

作　　者：刘高利[1] 王新[2] 胡海峰 宋恒雅 黄杰[1] 谢颂平[1] LIU Gaoli;WANG Xin;HU Haifeng(Department of Thoracic Surgery,Renmin Hospital of Wuhan University,Wuhan 430070,China)

机构地区：[1]武汉大学人民医院胸外科,430070 [2]河南省南阳市南阳市中心医院胸外科

出　　处：《临床外科杂志》2021年第7期643-645,共3页Journal of Clinical Surgery

摘　　要：目的总结分期手术策略应用于结肠代食管术的临床经验.方法行结肠代食管手术病人35例,均采用了分期手术策略,其中合并胃大部切除术后食管癌病人20例,食管癌术后再发食管癌5例,胸胃癌4例,食管癌病人术后存在并发症4例(气管食管瘘2例,胃坏死2例),食管化学灼伤并瘢痕狭窄放置食管支架导致气管食管瘘2例.其中先行食管病变切除术,择期再行结肠代食管术28例;7例病人先行结肠代食管术,择期行食管病损切除.结果35例病人均按计划方案顺利完成手术,分期行食管病变切除及结肠食管重建,手术的间隔时间为3~12个月.术后发生颈部吻合口瘘1例,乳糜胸1例,肺部感染2例,均经保守治疗后痊愈出院.随访1年病人均恢复正常饮食,体重较术前明显增加.结论分期手术策略应用于结肠代食管术效果良好,并发症较少.Objective To summarize the clinical experience of staging strategy in esophageal replacement with colon operation.Methods Thirty-five patients who underwent esophageal replacement with colon were used staging surgery,20 patients were with esophageal cancer after subtotal gastrectomy,5 patients with recurring esophageal cancer after esophageal cancer,4 patients with thoracic stomach cancer,2 patients with tracheoesophageal fistula after esophageal carcinoma resection,2 patients with gastric necrosis after esophageal carcinoma resection,and 2 patients with esophageal fistula caused by esophageal chemical burn and scar stenosis.Among the above-mentioned patients,28 patients underwent esophageal lesion resection first,followed by elective esophageal replacement with colon;7 patients underwent esophageal replacement with colon first and then elective esophageal lesion resection.Results All 35 patients were successfully performed staged surgery as planned,with the interval between operations ranging from 3 to 12 months.1 patient was with neck anastomotic fistula postoperative,1 with chylothorax and 2 with pulmonary infection,they were all cured after conservative treatment and discharged.After one year of follow-up,all the patients could eat normal diet and gained more weight than pre-operation.Conclusion The staging surgical strategy applied to esophageal replacement with colon has good results and fewer complications.

关 键 词：结肠代食管术 手术策略 分期 效果 

分 类 号：R655.4[医药卫生—外科学]