食管严重烧伤171例的外科治疗

Surgical treatment of severe esophageal burns： a report of 171 cases

目的探讨食管严重烧伤后瘢痕狭窄的预防及治疗效果。方法分析我科1976年4月至2007年6月外科治疗171例食管严重烧伤患者临床资料。其中37例Ⅱb度烧伤患者1个月内采用食管腔内置管预防瘢痕狭窄；108例已形成瘢痕狭窄者采用胃或结肠重建食管80例，胃重建28例；颈部食管局限性烧伤狭窄和术后吻合口狭窄者29例，采用颈阔肌皮瓣修复。结果37例食管腔内置管者中32例痊愈；结肠重建80例，术后死亡6例，颈部吻合口瘘14例，吻合口狭窄4例；胃重建28例，发生吻合口狭窄2例；颈阔肌皮瓣修复29例，无术后死亡，肌皮瓣全部存活，能正常进食。结论食管腔内置管是食管烧伤早期预防狭窄的有效方法；广泛食管瘢痕狭窄可旷置食管行结肠重建，狭窄食管位于主动脉弓以下者可切除狭窄食管用胃重建；局限性颈部食管狭窄或吻合口狭窄颈阔肌皮瓣修复是较理想的方法。

Objective To summarize the experiences in prevention and treatment of cicatricial stricture after severe esophageal bums. Methods A retrospective study was done based on the clinical data of 171 patients with severe esophageal bum who were treated from April 1976 to June 2007. Intraluminal esophageal stenting was performed on 37 patients with IIb degree esophageal bums; esophageal reconstruction on 80 and esophago-gastric reconstruction on 28 out of 108 patients with cicatricial stricture; platysma myocutaneous flap repair on 29 with postoperative anastomotic stricture or cervical esophageal stenosis caused by localized bum. Results Thirty-two of the 37 patients treated with intraluminal esophageal stenting were cured; of the 80 patients treated by esophageal reconstruction, 6 died postoperatively, 14 were found with cervical anastomotic fistula, and 4 with anastomotic stricture ; Anastomotic stricture occurred in 2 among the 28 patients who received esophago-gastric reconstruction ; as for the 29 repairs of cervical stricture with platysma myocutaneous flap, all the transplants were alive and all patients had normal diet after operation. Conclusions Intraluminal esophageal stenting is effective in preventing stricture formation at the early phase of esophageal hums. Esophagus can be reconstructed with colon for the patients with diffuse esophageal cicatrical stricture. The stenosed esophagus can be resected and reconstructed with stomach if it is under the aortic arch. Platysma myocutaneous flap repair is ideal in repairing local stricture in the cervical esophagus or anastomotic stricture.