结肠代食管治疗儿童腐蚀性食管狭窄

The Operative Occasion and Choice of Technique of Colon Interposition for Caustic Stricture of Esophagus in Children

目的 总结小儿结肠代食管手术操作经验和近远期疗效 ,探讨手术时机和手术方式选择。方法 17例食管化学性烧伤患儿采用胸骨后结肠代食管手术 ,术前均行胃造瘘术 ,手术方式改进主要是根据血管弓发育情况决定选取哪段结肠、减轻吻合口张力及结肠食管前壁分层缝合技术。结果 手术近远期主要并发症是颈部吻合口瘘和吻合口狭窄 ,分别为 2 7.0 %和 37.5 % ;手术改进后没有出现吻合口瘘 ,1例吻合口狭窄 ,总有效率达到 92 .8%。结论 结肠代食管手术后并发症较多 ,伤后 6月左右行食管替代手术 ,选取哪段结肠作为替代物要根据血管弓的发育情况 。

Objective To review operative experiences and short and long term curative effectiveness of colon interposition esophageal replacement in children, and to to discuss operative occasion and choice of technique. Methods Seventeen children with caustic injury underwent retrosternal colon interpositions for stricture. Gastrostomy was carried out in all children before operation. Six patients underwent modified operation after 1996. Results Major complications after operation were anastomotic leakage (27 0 %) and stenosis (37 5 %). All children had excellent outcome after modified procedures. Total effective rate was up to 92.8 %. Conclusion Although there are many complications after colon interposition esophageal replacement in children, the esophagus can be safely replaced by colon about 6 months after caustic injury. Long term function recovery was satisfactory.