食管化学烧伤后狭窄的手术治疗

The surgical treatment of caustic esophageal stricture

目的 探讨食管化学烧伤后狭窄的外科治疗及横结肠代食管手术的应用价值。方法 10 6例食管化学烧伤后狭窄的病人均采用横结肠代食管手术、保留结肠左动脉升支、胸骨后顺蠕动吻合,除横结肠咽腔吻合32例外,均横结肠食管颈部吻合。结果 无手术死亡。手术后发生颈部吻合口瘘12例、吻合口狭窄8例、气管切开3例,经治疗后均痊愈。结论 食管化学烧伤后应积极采取胸骨后横结肠代食管术,行横结肠食管颈部吻合或结肠咽腔吻合都是适宜的。

Objective To review the experience of surgical management for caustic esophageal stricture and discuss the surgical techniques of transverse colon interposition for esophageal replacement. Methods 106 patients with caustic esophageal stricture were treated surgically. 32 patients underwent colon interposition with colonphargageal anastomosis and others received colon interposition with a cerrical anastomosis. The ascending branch of the left artery of the transverse colon was preserved as the suppoiting vessel of the interpositioned colon. Results There was no postoperative death. The leakage of cervical anastomosis was observed in 12 patients, anastomosis stenosis in 8 patients, and tracheotomy was performed in 3 patients. All patients were perfectly recovered by the treatment. Conclusion Transverse colon interposition for esophageal reconstruction is an optimal approach in the treatment of caustic esophageal stricture.