保护替代食管的结肠段血供的措施

Preservative measures for blood supply to the colon segment in reconstruction of esophagus

目的 探讨保护替代食管的结肠段充分血供的有效措施。方法 根据循证医学随机对照研究 ,分析 6所医院不同时期实施结肠重建食管术的术式及结果。结果 5 48例术后总并发症率15 2 % ,病死率 1 8% ,未发生结肠段缺血、坏死。近阶段施术的 10 0例吻合口漏率 5 % ,并发症率 8% ,病死率 1 0 %。结论 保证结肠段充分血供的有效措施为①结肠段边缘血管弓完整 ,且无张力 ,供血充分 ;②结肠段上提通道宽畅 ;③保证稳定的动脉压 ;④采用一层吻合术 ;

Objective: To study the effective protective measures ensuring sufficient blood supply to the colon segment replacement of esophagus. Methods: According to evidence based medicine, the various operative approaches and results in six hospitals have been analyzed by random control study. There were totally 548 patients in this study. Results: The incidence of post operative complication was 15 2% and overall mortality was 1 8%. There was no necrosis. Among one hundred cases performed in recent years, the incidence of anastomotic leaks, post operative complications and mortality were 5%, 8% and 1% restectively. Conclusion: The preservative measures for good blood supply to the colon segment include the following aspects: (1)maintaining complete marginal vascular arcade without tension in the mesocolon; (2)reaching 4 finger width pathway; (3)maintaining the stable blood supply; (4)performing a single row anastomosis; (5)attention to the comprehensive peri operative management.