咽结肠吻合治疗食管烧伤后瘢痕狭窄

Pharyngo-colonic anastomosis for esophageal reconstruction in the treatment of diffuse corrosive esophageal stricture

目的 总结采用咽结肠吻合治疗食管烧伤后瘢痕狭窄的经验及效果。方法 回顾分析14例应用咽结肠吻合重建食管治疗累及下咽的广泛食管烧伤后瘢痕狭窄患者的临床资料。均采用左半结肠 ,旷置胸内瘢痕食管、经胸骨后隧道上提至颈部行咽结肠吻合。结果 全组无手术死亡 ,术后发生颈部吻合口漏 4例 ,腹部切口裂开 1例。随访半年至 10年 ,平均 4年 ,2例分别于术后 3个月及 4个月发生吻合口狭窄 ,1例扩张 ,1例行成形术治愈 ;1例因移植结肠腹腔段呈袋状而致进食后呕吐 ,行结肠胃侧侧吻合治愈。结论 咽结肠吻合治疗累及下咽的广泛性食管烧伤后狭窄成功关键是较大的下咽开口及良好的吻合技术 ,咽结肠吻合是安全、有效的。

Objective To observe the experience and the outcome of pharygocolonic anastomosis for esophageal reconstruction in diffuse corrosive esophageal stricture involving hypopharynx. Methods This retrospective report reviews the experience and results of 14 patients who underwent esophageal reconstruction by pharyngocolonic anastomosis without resection of intra thoracic stricture esophagus.The left half colonic segment was pulled up to the neck through the substernal space in all patients. Results There was no operative or hospital death.Postoperative complications include cervical anastomotic fistula in four patients,rupture of the abdominal incision in 1.The length of follow-up ranged from half year to 10 years with an average of 4 years.Anastomotic stenosis occurred in 2 patients.One case improved after dilatation and the other one healed by plastic operation.One patient began to vomit after diet in seven months later with barium swalloing the abdominal colon graft was redundant and this patient was cured with side by side between the colon and the stomach. Conclusion The successful reconstruction for hypopharyngoesophageal stricture requires a correct and larger hypopharyngeal opening and a good anastomotic tetchnic.From our experience this procedure is shown to be safe and effective.