结肠代食管手术的临床应用(附28例报告)

Clinical application of colonic interposition for esophageal substitution:an analysis of 28 cases

目的 :探讨结肠代食管手术的适应证及应用技术。方法 :本组共 2 8例。其中 4例贲门癌 ,9例为曾作胃大切的食管癌 ,12例为各种原因引起的食管或吻合口狭窄、梗阻 ,3例为吻合口瘘作食管外置者 ;结肠采用顺蠕动和逆蠕动各 14例。结果 :2 7例康复出院。主要并发症中颈部吻合口瘘 4例 ( 3例治愈 ,1例继发呼衰死亡 ,腹壁感染 1例。结论 :必需慎重选择结肠代食管手术的适应证 ,尤对姑息性手术及吻合口良性狭窄的病例更应严格选择。结肠代食管成功的关键是良好的血运和熟练的技术 。

Objective:To study the indications and technical problems of colonic interposition for esophageal substitution. Methods:28 patients underwent colonic interposition for esophageal substitution.Among them,four patient with cardiac carcinoma,nine patients underwent subtotal gastrectomy with esophageal carcinoma,twelve patients with esophageal strictures due to various causes,and 3 patients with esophagostomy due to anastomotic leakage. The nmbers of colon interposition were performed using the colon segment in isoperistaltic position and in reversed peristaltic position in both 14 cases. Results:27 cases were cured. the main postoperative complications included leakage at cervical region in 4(3 were cured,1 died from secondly respiratory failure)and abdominal incision infection. Conclusions:The indications of colonic interposition for esophageal substitution should be strictly choosen.The choice of colonic segment for interposition is dependent on sufficient blood supply.There is no obvious difference of effect between isoperistaltic and reversed peristaltic position of the colon.