548例结肠代食管术的临床经验

Clinical Experience of Esophageal Replacement with Colon on 548 Cases

目的:探讨结肠代食管术（ERC）的适应证、围术期处理及手术技术。方法:分析1962-1999年ERC 548例资料,病种概括为7类,其中恶性食管病变占79.56％,选用左结肠动脉作为供血管者占73.90％,替代肠段上提径路以胸骨后通道占55.83％。结果:术后总并发症率15.69％,病死率1.82％。术后1,3,5年生存率分别为85.6％,60.8％,32.4％。结论:首选结肠左动脉为结肠段供血管,肠段上提径路以胸骨后通道为优。对患颈、胸上段食管癌病例施行不开胸食管拔脱加ERC,保留迷走神经者,术后生存质量属优。因此拓宽ERC适应证是可行的。

Objective: To study the indications, perioperative management and surgical technique of esophageal replacement with colon(ERC) . Methods: From September 1962 to September 1999, 548 patients underwent ERG procedure, including 376 males and 172 females,aging from 2 to 74 years old. The disease spectrums were esophageal cancer in 417 cases, corrosive esophageal stricture in 87,esophageal rupure in 13, esophagotracheal fistula in 16, multiple esophageal divertic-ulum in 1 , reflux esophagitis with hemorrage in 2 and rnegaloesophagus in 11 . There was malignant esophageal disease in 79.6% , total esophagectomy with ERG in 54.0% , left colic artery as supply blood vessel in 73.9% ,retrosternal route in 55.9% . Results: The overall postoperative morbidity was 15,7% and the mortality was 1,8% . None ischemic necrosis of the colon segment occurred. The actual 1,3,5 years postoperative survival rate was 85 .1 % , 60.8 % and 32. 4% respectively. All patients in benign esophageal diseases group survived well with normal life activities from 2 to 25 years of follow-up. Conclusion: The experience of surgical procedures indicate: 1 .The ascending branch of the left artery serves as the preferable blood supplying vessel, 2 . Isoperistal ic and retrosternal transposition of the colon is used as possible as we can. 3. Less or no blood transfusion. 4. Esophagectomy without thoracotomy is selected for cervical and upper thoracic esophageal cancer. 5 . The vagal nerve is preserved.