结肠代食管消化道重建术疗效分析

Effects analysis of colon interposition for alimentary reconstruction after esophagectomy

目的分析结肠代食管消化道重建的治疗结果。方法收集上海市胸科医院1985年6月至2015年6月30年间行食管手术的患者资料,选取其中107例结肠代食管手术患者,分析手术指证、手术方式选择和早期治疗结果。结果全组男性占75.5%（81/107）,恶性肿瘤占58.9%（63/107）,食管化学伤占28.9%（31/107）。结肠左动脉升支供血顺蠕动是最主要的间置结肠选择,占79.4%（85/107）,胸骨后路径占91.6%（98/107）。颈部吻合占95.4%（102/107）,术后住院时间（32±22）d（13～121d）。吻合口瘘发生率为19.6%（21/107）,狭窄发生率为8.4%（9/107）,移植结肠坏死率为1.9%（2/107）,住院病死率为0.9%（1/107）。既往胃手术史、糖尿病是术后吻合口瘘的危险因素。结论结肠代食管是复杂食管重建的必要手段,其近期病死率在可接受范围内。

Objective To analyze the outcomes of colon interposition for alimentary reconstruction after esophagectomy.Methods The clinical data of patients undergoing esophagectomy in Shanghai Chest Hospital between June 1985 and June 2015 were reviewed.Colon interposition was performed in107 of these patients,and the surgical indications,surgical techniques and early outcomes after operation were analyzed.Results Eighty-one patients（75.5%）were males.Malignance accounted for 58.9%（63/107）,and corrosive injury 28.9%（31/107）.The isoperistaltic left colon interposition with blood supply from the ascending branch of left colic artery was the predominant selection of colon transplantation,which accounted for79.4%（85/107）.The retrosternal approach was adopted in 91.6% of patients（98/107）.A total of 95.4% of anastomosis（102/107）was in the neck.The mean in-hospital time after operation was（32±22）d（13-121d）.Anastmostic leak took place in 19.6% of patients（21/107）,stricture in 8.4%（9/107）,and interposed colon necrosis in 1.9%（2/107）.The surgical mortality was 0.9%.The history of stomach operation and diabetes were the risk factors of leak.Conclusions Colon interposition is the mainstay of the complex esophageal reconstruction,and the morbidity and mortality are acceptable.