摘要
目的探讨胃代食管和结肠代食管手术治疗儿童食管严重瘢痕狭窄的疗效及生活质量。方法回顾性分析1998年7月-2008年7月我院收治的149例食管严重瘢痕狭窄症儿童的临床资料，行胃代食管术的115例，行结肠代食管手术34例的。对照两组患者术后主要并发症（替代物坏死、替代物扭转、胃排空延迟、结肠胃吻合口狭窄）和次要并发症（颈部吻合口瘘、腹泻、颈部吻合口狭窄、胃结肠反流）的发生率及死亡率。结果结肠代食管组有1例（0．8％）出现替代物坏死，胃代食管组也有1例（2．9％）出现替代物坏死，结肠代食管组的次要并发症较胃代食管组高（P=0．001），但主要并发症较少（P=0．001）。所有并发症都给予正确的处置，没有出现不良后果。两组患者的死亡率没有明显区别（P）．0．05）。结论结肠代食管术和胃代食管术都是儿童食管替代的理想手术方式。但在考虑到主要并发症的问题，结肠代食管术应该是儿童食管替代的最好的选择。
Objective ： To review the authors＇ experience with these 2 techniques and compare the complications of these operations to determine whether 1 method emerges superior to the other.Methods： A total of 149 children underwent surgery： 115 children underwent esophagocoloplasty, and 34 children underwent gastric transposition.Complications and mortality of the 2 groups of patients were compared. These complications were classified as minor （cervical anastomosis leak, diarrhea, strictures, and reflux to the interposed viscera） and major （necrosis of transposed viscera, intrapleural suture, torsion of transposed viscera, delayed gastric emptying and cologastric anastomosis stricture）.Results： There were 2 graft necrosis, 1 （0.8%） in the esophagocoloplasty group and another （2.9%） inthe gastric transposition group. Patients who underwent esophagocoloplasty experienced a greater incidence of minor complications （ P = 0.01） and less major complications in comparison with the gastric transposition group （ P = 0.01）. All minor complications were treatable and had no consequences. No difference was noted between the 2 groups with regard to the mortality rate （0.9%and 5.9%, respectively, P 〉0.05）.Conclusions： Esophagocoloplasty and gastric transposition are satisfactory means of esophagealsubstitution in children. Considering the incidence of major postoperative complications, esophagocoloplasty must be the first choice for esophageal replacement in children.
