结肠或胃重建食管治疗食管烧伤后瘢痕狭窄100例

目的 总结结肠或胃重建食管治疗食管烧伤后瘢痕狭窄的临床经验及疗效。方法回顾分析100例应用结肠或胃重建食管烧伤后食管瘢痕狭窄的临床资料。74例未切除瘢痕段食管，结肠经胸骨后隧道上提至颈部或咽部吻合；26例经胸切除瘢痕段食管，行食管胃胸内吻合23例，颈部吻合3例。结果结肠重建食管死亡5例（6．8％），术后发生颈部吻合口瘘14例（18．9％），吻合口狭窄5例（6．8％）。26例胃重建食管者无死亡，术后发生吻合口狭窄2例，脓胸1例。结论食管烧伤后高位的广泛狭窄可旷置瘢痕段食管采用结肠重建，中下段病变能在主动脉弓下吻合者可切除瘢痕段食管用胃重建，提高外科技术可明显降低结肠重建食管的并发症。

Reconstructive operation with colon or stomach for scarred stricture after esophageal burns

Objective To summarize the experience and the outcome of the reconstructive operation with colon or stomach for scarred stricture after esophageal burns. Methods This retrospective report reviews the clinical history of reconstructive operation with colon or stricture for scarred stricture after esophageal burns. 74 cases underwent esophageal reconstruction by colon without resection of scarredes esophagus, 26cases esophagogastric reconstruction withresection of scarred esophagus.Resultsed In the group reconstructed with colon there were 5 postoperative deaths, including mediastinal infection caused by necrosis of transposition colon in 2 cases. Other postoperative complications included cervical anastomotic leakage in 14 cases and anastomotic stenosis in 4 cases. In the group reconstmcted with stomach, there was no operative death and only 2 anastomotic stenosis and one empyema occurred after operation. Conclusion The proximal esophageal scarred stricture beyond the lower edges of aortic arch could be replaced by colon bypass without resecting the scarred esophagus. The esophagogastrostomy ould be performed after excising scarred esophagus with the anastomosis can be made below the aortic arch. The postoperative complications in the group of reconstruction with colon were higher than the group of reconstruction with stomach. Improvement in surgical technique may decrease the comphcation rate of reconstmction with colon.