结肠或胃重建食管治疗食管腐蚀伤后瘢痕狭窄

Reconstruetive Operation With Stomach or Colon for Scarred Stricture After Esophageal Caustic Injury

1986年～1996年12月，我科采用结肠或胃重建食管治疗食管腐蚀伤后瘢痕狭窄65例。47例采用结肠重建（未切除病变食管），结肠经胸骨后上提至颈部，吻合部位在颈部41例，咽部6例；经左胸用胃重建18例，其中17例切除了瘢痕的食管，1例行短路手术。结肠重建组3例术后死亡包括2例结肠坏死，颈部吻合口瘘11例，胃重建组术后无死亡病例，仅1例出现颈部吻合口瘘。作者认为瘢痕狭窄食管近端超过主动脉弓下缘者，可行食管旷置，用结肠重建，如狭窄在食管下段，可切除病变食管，行食管胃主动脉弓下吻合。

Sixty-five patients with severe and extensive scarred stricture after esophageal caustic injury were surgically treated fron 1986 to 1996. The replacement with colon was trans -substernal up to the neck in 47 cases and anastomotic site was in the neck in 41cases and in the pharynx in 6. The replacement with stomach through left thoracotomy was perfoumed in 18 cases and the scarred esophagus wsa resected in 17 cases and by-pass was made in 1 case. The results showed that in the group reconstructed with colon,there were 3 cases died in the hospital incluing colonic necrosis in 2 cases and 11 cases complicated with cervical anastomotic leakage. In the group reconstructed with stomach, there was no death and only one cervical anastonotic leakage occurred. Conclusively, we believe that the proximal esophageal searred stricture beyond the lower edges of aortc arch could be replaced with colon without resecting the scarred esophagus and the csophagogastrostomy could be performed after excising scarred esophagus if the anastomosis can be made below the aortic arch. The cause and prevention of complications such as esphageal anastomotic leakage and necrosis of the transplanted colon are also discusscd in this paper.