结肠代食管在食管切除术后消化道重建中的应用

目的 探讨结肠代食管用于食管切除术后消化道重建的安全性。方法回顾性分析1992年10月至2010年10月在四川省肿瘤医院胸外科接受结肠代食管手术的136例食管癌患者的临床资料。结果136例患者中118例利用左结肠动脉升支供血实施横结肠间置肠段顺蠕动：18例利用结肠中动脉供血,其中12例取右半横结肠和部分升结肠做成顺蠕动,6例取左半横结肠和部分降结肠做成逆蠕动。围手术期并发症发生率26．4％（36／136）,死亡率12．5％（17／136）．其中移植结肠穿孔5例,死亡4例;胸内吻合口瘘5例,均死亡;颈部吻合口瘘10例,无死亡病例：重症肺部感染10例,死亡4例;急性呼吸窘迫综合征7例,死亡3例;不明原因全身感染1例,死亡。术后远期并发症中,吻合口狭窄2例,反流2例,食物运行障碍3例。结论尽管结肠代食管术操作复杂、创伤较大、术后并发症发生率和死亡率均较高,但对于不能使用胃代食管的患者。结肠代食管仍是一种较好的选择。

Application of colonic interposition in the digestive tract reconstruction after esophagectomy

Objective To evaluate the safety of colonic interposition after esophagectomy. Methods One hundred and thirty six patients with esophageal cancer underwent colonic interposition after esophagectomy in the Sichuan Tumor Hospital from October 1992 to October 2010. Clinical data of these patients were retrospectively reviewed. Results Out of the 136 patients, 118 grafts were transverse colon in clockwise peristalsis supplied by ascending branches of the left colonic artery. Twelve grafts were right part of transverse colon and ascending colon in clockwise peristalsis. Six grafts were left part of transverse colon and descending colon in counterclockwise peristalsis. All the 18 grafts were supplied by the middle colonic artery. The total perioperative complication rate was 26.4％ (36/136),including anastomotic leakage in 15 cases, colon necrosis in 5 cases. The mortality was 12.5％(17/136), in which 5 patients died of colonic perforation, 4 died of colon necrosis, 4 died of severe lung infection after operation, 3 died of ARDS and 1 died of systemic infection of unknown origin.Anastomotic stenosis occured in 2 patients, reflux in 2cases, and 3 patients suffered from bowel dysmotility. Conclusions Colon interposition is a complex procedure with significant trauma, high morbidity, and morality. However, it is a valid alternative to reconstruct the gastrointestinal tract when the stomach is not feasible.