食管、贲门癌切除横结肠移植食管、胃重建术的体会

目的　扩展食管、贲门癌切除食管胃重建术的范围。方法　对胃溃疡胃大部分切除术后 9年又患胸中段食管鳞癌行根治性切除经食管床作横结肠胃食管颈部吻合术 1例 ;贲门癌侵犯食管下段行食管次全切除、全胃切除经食管床作横结肠空肠食管颈部吻合术 1例 ;另外 3例均因贲门癌行全胃切除 ,横结肠十二指肠食管弓下吻合术。本组 5例均切断中结肠动脉采用左结肠动脉升支供血的横结肠行顺蠕动向吻合。结果　其中 1例结肠胃食管颈部吻合术的病人 ,术后第 9日发现颈部吻合口瘘 ,术后第 2 3天痊愈出院。其余 4例病人均顺利出院。结论　横结肠有丰富的血供及足够的长度可移植至任何高度与食管吻合且愈合满意。

Experience of esophagus and gastric reconstruction for the treatment of esophageal and cardia carcinoma by transverse colon

Objective To expand the operation method of esophagus and gastric reconstruction after resection of esophageal and cardia carcinoma. Method Among the group of five patients, 1 patient received partial gastrectomy for gastrecoma, and nine years later, underwent radically resection of the esophageal squamosum carcinoma in middle chest, then received cervical gastroesophagestomy by transverse colon. 1 case was performed with subtotal esophagectomy because of invasion to the lower part of esophagus of cardia carcinoma, and total gastric resection and cervical esophagojejunostomy by transverse along the esophageal bed . Another three patients were operated on by total resection and esophaduodenostomy by transverse colon. In this group, they all underwent the arteria colica media and performed anastomosis along the peristaltic direction by the transverse colon, which supplied blood by the rami ascendens on arteria colica sinistra. Result 1 patient, who performed the cervical gastroesophagostomy, was found the cervical anastral fistual 9 days later, and 23 days after operation he was treated successfully. Others were out of hospital safely after operation. Conclusion Transverse colon was rich in blood and enough in length. It can be grafted and anastomy with the esophagus to either height and the result is very good.