结肠间置术治疗胃切除术后食管癌

目的 探讨结肠间置术治疗胃切除术后食管癌的疗效。方法 对26例胃切除术后食管癌患的手术方式、并发症、治疗结果及术后胃肠功能进行分析。结果 1例移植段结肠颈段坏死，4例颈部吻合口瘘，1例术后8d死于急性心肌梗死。结肠顺蠕动间置18例，1年生存率77．8％，2年生存率44．5％；结肠逆蠕动间置8例，1年生存率62．5％，2年生存率37．5％。胃肠功能等级评定显示，结肠顺蠕动间置术后胃肠功能优于结肠逆蠕动间置。结论 胃切除术后腹膜腔的严重粘连和胃空肠吻合口的压迫可导致横结肠短缩和结肠左动脉分支变细。手术中应力争行结肠顺蠕动间置。

Colon interposition in the treatment of esophageal carcinoma after gastrectomy

Objective To evaluate the clinical effect of colon interposition in the treatment of esophageal carcinoma after gastrectomy. Methods Colon interposition for esophageal replacement was performed on 26 cases with esophageal carcinoma after gastrectomy. Clinical data including various surgical procedures, complications, outcomes and postoperative alimentary functions were reviewed retrospectively. Results Cervical part necrosis of colon graft occurred in one case and cervical anastomotic leakage in 4 cases. One patient died of acute myocardial infarction on the 8th day after operation. Colon interposition was placed in isoperistaltic fashion in 18 patients, in antiperistahic fashion in 8, and the overall 1 and 2 year survival rates were 77.8% and 44.5%, 62.5% and 37.5% respectively. Alimentary function grading revealed that isoperistahic colon interposition was better than antiperistaltic fashion. Conclusions Serious adhesions in the abdominal cavity and compression of gastrojejunal anastomotic stoma after gastrectomy may cause shortening of the transverse colon and narrowing of left colonic artery and its branches. It is preferable that colon interposition be performed in an isoperistahic fashion.