结肠或胃代食管术治疗食管腐蚀伤后瘢痕性狭窄

目的总结结肠或胃代食管术治疗食管腐蚀伤后食管瘢痕狭窄的临床经验.方法食管腐蚀伤后食管瘢痕性狭窄患者46例,伤后1～6个月内手术41例,其中3～4个月手术28例;6个月以上5例.采用结肠代食管术43例,胃代食管术3例.结果全组无手术死亡.术后发生颈部吻合口瘘4例,吻合口狭窄2例,腹壁切口裂开1例,均治愈.随访41例,最长随访3年,除2例进软食时有哽噎感外,其余患者均能正常进食.结论采用结肠代食管术治疗食管腐蚀伤后瘢痕狭窄是一种理想的手术方法.     

食管腐蚀性烧伤后严重狭窄的外科治疗

目的探讨食管腐蚀性烧伤后狭窄的外科治疗经验及胃或横结肠代食管重建手术的应用价值。方法对98例食管腐蚀性烧伤后狭窄的患者中72例广泛食管狭窄、病变超过食管中段以上者采用横结肠代食管、保留结肠左动脉升支、胸骨后顺蠕动吻合,其中横结肠咽腔吻合18例,横结肠食管颈部吻合54例,胸段食管旷置不切除;26例狭窄位于中下段,经胸切除瘢痕段食管用胃重建食管,胃食管胸内吻合。结果结肠食管重建72例中,术后死亡4例（5．56％）,发生颈部吻合口瘘14例（19．44％）,后期出现颈部吻合口狭窄7例,经治疗后均痊愈。胃重建食管26例无手术死亡,术后发生胸内吻合口狭窄3例,经扩张治愈。结论食管腐蚀性烧伤后狭窄在伤后20～24周可积极采取食管重建术,根据食管狭窄段严重程度及位置决定是否行狭窄段食管切除、选择食管重建替代物及吻合的位置。可采用横结肠食管颈部吻合或结肠咽腔吻合术,胸内胃食管吻合术。     

食管腐蚀伤的外科治疗

目的总结食管腐蚀伤的外科治疗经验。方法149例食管腐蚀伤患者,除7例行保守治疗外,其余142例采用外科手术治疗(其中11例在我科行2次手术)。采用改良食管腔内置管28例,于腐蚀伤后6个月行食管重建术96例(结肠代食管71例、胃代食管25例),颈阔肌皮瓣修复颈段食管局限性狭窄或吻合口狭窄17例,其他手术12例。结果7例保守治疗的患者中死亡2例,余5例Ⅰ度烧伤患者未形成瘢痕狭窄。手术治疗142例中,行结肠代食管术患者死亡5例,发生颈部吻合口瘘14例,颈部吻合口狭窄8例,脓胸1例。改良食管腔内置管28例,23例成功,再狭窄5例经再次手术或食管扩张治愈。存活患者均恢复正常进食。结论改良食管腔内置管可预防食管瘢痕狭窄;食管狭窄位于主动脉弓平面及以上时,旷置瘢痕食管行结肠代食管术,而位于主动脉弓平面以下时,切除瘢痕食管采用胃代食管术重建食管;颈阔肌皮瓣可用于修复颈段食管狭窄或吻合口狭窄。     

儿童食管腐蚀伤的外科治疗

目的　探讨儿童食管腐蚀伤后瘢痕狭窄的预防和治疗措施。　方法　 1988年 5月～ 2 0 0 0年 5月收治食管腐蚀伤儿童 32例 ,早期采用食管扩张 3例 ,食管腔内置管 8例 ;后期采用结肠代食管 14例 ,胃代食管 5例 ,颈阔肌皮瓣修复 2例。　结果　全组手术治愈 31例 ,死亡 1例 ;术后发生并发症 9例 ,其中吻合口瘘 6例 ,吻合口狭窄 2例 ,颈部瘘 1例 ,均治愈。 2 8例随访 1～ 12年 ,均恢复进普通饮食 ;3例失访。　结论　早期食管腔内置管对预防食管腐蚀伤后瘢痕狭窄有明显疗效 ,结肠代食管术是后期食管重建的主要手段 ,主动脉弓以下瘢痕食管可切除用胃重建 ,颈阔肌皮瓣修复术是治疗颈部局限性食管狭窄的理想方法     

腐蚀性食管狭窄的外科治疗体会

本文报告了６例化学腐蚀剂食管灼伤后狭窄的手术治疗体会、致伤物氢氧化钠３例；氢氧化氨１例，硫酸２例，一般化学腐蚀剂造成的食管瘢痕性狭窄多发生在受伤６周之后，食管重建术应在灼伤半年后进行，术前胃瘘及空肠瘘的建造应考虑到后期食管重建术的需要，在诸多食管代用脏器中，我们认为须行性胃大弯管代食管术有许多优点，吻合口瘘是食管重建术后最常见的严重并发症，本文在分析其发生原因的基础上，谈了我们对预防术后吻合口瘘所     

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。     

58例结肠代食管术治疗食管良性狭窄

目的 总结结肠代食管手术治疗食管良性狭窄的经验及效果.方法 58例中男39例,女19例.年龄16～67岁,平均36岁.先天性食管狭窄2例,创伤性3例,瘢痕性狭窄53例(均为腐蚀剂烧伤).行一期游离空肠,咽空肠吻合术,远端空肠旷置,二期结肠代食管术3例次;胸骨后途径食管结肠颈部端侧吻合转流术56例次.结果 无手术死亡,手术经过较为顺利.术后出现全结肠坏死2例、吻合口瘘7例、吻合口狭窄2例、左喉返神经损伤3例.52例随访1～16年,1级(效果极好)40例、2级(很好)9例、3级(满意)2例、4级(不满意)1例.结论 结肠代食管术是治疗食管良性狭窄较为理想的手术.     

小儿食管碱烧伤瘢痕狭窄的外科治疗

目的　探讨小儿食管碱烧伤瘢痕狭窄采用回结肠代食管手术治疗的适应证和术后并发症的处理。方法　采用胸骨后径路、回结肠代食管术治疗小儿食管碱烧伤瘢痕狭窄 13例。　结果　 13例均无术中和术后死亡。术后发生颈部吻合口瘘 2例 ,吻合口狭窄 3例。随访 11例 ,随访时间 2 3～ 4 0个月 ,平均 3 6个月 ,除 1例偶有呕吐外 ,其余10例进食和生长发育均正常。　结论　采用回结肠代食管术治疗小儿食管碱烧伤瘢痕狭窄是一种有效的方法。     

食管腐蚀性瘢痕狭窄的外科治疗

为了观察食管腐蚀性瘢痕狭窄的外科治疗效果，自1980年至1995年间我们为14例食管腐蚀性瘢痕狭窄病人行结肠移植咽下食管斜切口吻合。结果，吻合口瘘1例，换药2周治愈；吻合口狭窄2例，全组无手术死亡。术后随访10年生存11例，全部进食良好，吞钡检查吻合口正常。我们认为结肠移植咽下食管斜切口吻合治疗食管腐蚀性瘢痕狭窄效果满意。     

食管癌和贲门癌术后吻合口重度瘢痕狭窄的外科治疗

目的总结食管癌和贲门癌术后吻合口重度瘢痕狭窄外科治疗的经验。方法对24例重度吻合口瘢痕狭窄并下咽困难的患者行二次手术治疗。其中,原发肿瘤为食管癌17例(9例为颈部食管胃吻合,8例为胸内食管胃弓上吻合),贲门癌7例(6例为胸内食管胃弓下吻合,1例为经腹食管胃膈下吻合);狭窄段长0,3～0．5cm、在瘢痕基础上形成蹼状者18例,狭窄段长0．5～1．0cm、环形狭窄呈收缩状者6例。二次手术解剖吻合区的吻合口上下各1—2cm范围,在距吻合线上下各2～4mm处分别切开一半食管腔和胃腔,然后切除部分瘢痕狭窄环组织,再行食管-胃单层吻合。结果24例成功地完成二次手术,1例出现颈部吻合口瘘,无手术死亡。术后随诊2—3年,患者可顺利进软食和普食,未发生二次吻合口狭窄,生活质量明显提高。结论食管癌和贲门癌术后发生的吻合口重度瘢痕狭窄,可行二次手术切除部分瘢痕狭窄环再吻合,效果较好。     

Gastric tube interposition for corrosive esophagitis associated with pyloric stenosis

Corrosive esophagitis, caused by swallowing corrosive acid or alkali, results in cicatricial stricture of the esophagus. The stricture is often accompanied by pyloric stenosis because strong acids act synergistically with gastric juice. Resection of both the esophagus and stomach is usually necessary, and the colon or jejunum is used as an esophageal substitute. We describe how we successfully treated corrosive esophagitis associated with pyloric stenosis, by performing gastric tube interposition for the esophageal reconstruction. After resecting the injured distal part of the stomach, we pulled the pedunculated gastric tube up to the cervix after anastomosis to the jejunal limb in a Roux-en-Y fashion. This reconstruction procedure prevented excessive organ sacrifice and was minimally invasive. Thus, esophageal reconstruction by interposition using a pedunculated gastric tube can be used effectively to treat corrosive esophagitis associated with pyloric stenosis.     

Corrosive injury-induced gastric outlet obstruction: a changing spectrum of agents and treatment.

METHODS: During the last 5 years, 61 children were admitted to the authors' hospital because of corrosive substance ingestion, and among them 6 patients were seen with gastric outlet obstruction. Two of them had ingested acid substances, and the other 4 had ingested alkali corrosives. The mean age was 2.9 years (range, 1.5 to 3). Their common complaint was postprandial vomiting, which had begun 3 weeks after the event (range, 1 week to 10 weeks). Endoscopic evaluation and barium contrast radiographies were performed at admission. Four patients had a pyloric stricture, 1 had an antral stricture, and another had an antropyloric stricture. Balloon dilatation of the pylorus (in 1 patient), pyloroplasty (in 3 patients), and Billroth I procedures (in 2 patients) were performed. The mean follow-up period was 22 months (range, 6 weeks to 48 months). One patient, who had undergone a Billroth I procedure, underwent reoperation because of intestinal obstruction 3 months later. On follow-up they are all free of symptoms. CONCLUSIONS: The treatment of gastric outlet obstruction caused by corrosive ingestion should be treated surgically. Although endoscopic and radiologic evaluation helps to determine the time and necessity, once the diagnosis is confirmed, early definitive surgical intervention should be performed, and the type of the surgery depends mostly on the findings of the surgeon at laparotomy. Endoscopic balloon dilatation of the pylorus maybe attempted in suitable cases. Special care should be given to prevent children from accidental corrosive ingestion.     

Minimally invasive repair of a late stricture in a reversed gastric tube

Ingestion of caustic agents may result in severe scarring and stricture formation of the esophagus. Reversed gastric tube esophagoplasty is an option for definitive surgical management of severe esophageal stricture refractory to medical treatment. Delayed complications from this procedure have rarely been reported. We present a case involving a patient who developed a delayed gastric stricture three decades after receiving a reversed gastric tube esophagoplasty. A historical review of the reversed gastroplasty is presented as well.     

The management of extensive corrosive esophageal strictures: Do not dilate and procrastinate

Corrosive strictures of the esophagus are difficult to treat, however, prompt and appropriate management of corrosive burns to the esophagus can prevent the formation of strictures. In a developing country like India, where facilities for early treatment are not easily available, strictures are an ineviatable consequence. If the strictures are extensive, dilatational therapy proves ineffective and offers no substantial benefit to the patients. Twenty patients with extensive corrosive strictures of the esophagus were surgically managed; by esophageal bypass in 13 and esophagectomy in 7. Surgical treatment restored normal swallowing in all the patients. The common post-operative complications to occur were: pulmonary complications, anastomotic leak and stricture, gastric outlet obstruction and reflux esophagitis. For extensive corrosive strictures of the esophagus, we advocate early surgical treatment rather than prolonged dilatational therapy.     

The management of extensive corrosive esophageal strictures: do not dilate and procrastinate

Corrosive strictures of the esophagus are difficult to treat, however, prompt and appropriate management of corrosive burns to the esophagus can prevent the formation of strictures. In a developing country like India, where facilities for early treatment are not easily available, strictures are an inevitable consequence. If the strictures are extensive, dilatational therapy proves ineffective and offers no substantial benefit to the patients. Twenty patients with extensive corrosive strictures of the esophagus were surgically managed; by esophageal bypass in 13 and esophagectomy in 7. Surgical treatment restored normal swallowing in all the patients. The common post-operative complications to occur were: pulmonary complications, anastomotic leak and stricture, gastric outlet obstruction and reflux esophagitis. For extensive corrosive strictures of the esophagus, we advocate early surgical treatment rather than prolonged dilatational therapy.     

Management of corrosive esophageal burns in 149 cases

OBJECTIVES: We sought to present our experience in the management of esophageal burns. METHODS: From April 1976 through October 2003, 149 patients with corrosive esophageal burns were included in this study. Treatment modalities consisted of modified intraluminal stenting in 28, colon interposition in 71, gastric transposition in 25, repair of cervical stricture with platysma myocutaneous flap in 17, and miscellaneous operations in 12 patients. Eleven of these patients underwent the above procedures twice at our institute. The remaining 7 patients were treated with conservative therapy. RESULTS: Twenty-three patients recovered from intraluminal stenting, and 5 experienced stricture after stent removal. One of the 5 patients with failed stents responded to bougienage, and the remaining 4 patients required esophageal reconstruction later. Of the 71 colon interpositions, 5 patients died postoperatively, and complications consisted of proximal anastomotic fistula in 17, anastomotic stenosis in 6, and abdominal incision dehiscence in 2 patients. Postoperative complications in the 25 patients with gastric transpositions comprised anastomotic stricture in 2 patients and empyema in 1 patient. There was a cervical leak in 1 of the 17 patients undergoing the repair of cervical esophageal or anastomotic stricture with a platysma myocutaneous flap. One of the patients in the group undergoing 12 miscellaneous procedures died 8 months after surgical intervention. All the survivors currently eat regular diets. CONCLUSIONS: Intraluminal stenting can prevent the formation of caustic esophageal stricture. The location of the cicatricial esophagus dictates whether to perform concomitant esophagectomy during esophageal reconstruction. Platysma myocutaneous flap repair is an excellent method for the treatment of severe cervical esophageal or anastomotic stricture.     

Barrett's esophagus in children. Diagnosis and management.

OBJECTIVE: To determine the local prevalence and optimal therapy for children with Barrett's esophagus (BE), the authors studied children with esophageal strictures or gastroesophageal reflux (GER), or both, to diagnose BE and to follow after therapy. SUMMARY BACKGROUND DATA: Barrett's esophagus is seldom reported in children and therapeutic recommendations are unclear. Barrett's esophagus usually develops during the mucosal reparative process after acid-reflux injury to the esophageal mucosa. Risk factors for BE include conditions that are associated with GER such as mental retardation, esophageal stricture, esophageal atresia, and reversed gastric tube esophagoplasty. Barrett's syndrome increases the risk of esophageal adenocarcinoma by 30 to 40 times. METHODS: All children with the risk factors had repeated esophagoscopy and multiple mucosal biopsies before and after therapy. RESULTS: Eleven children have been documented with BE. The initial diagnoses were: GER, 5; esophageal atresia, 4; nasogastric intubation, 1; lye ingestion, 1. A gastric tube esophagoplasty had been performed in three patients with BE in the esophagus proximal to the anastomosis. Three children with mid-esophageal strictures and long segments of BE had total resection with colic interposition. An additional two patients with tight stricture were treated with colic-patch esophagoplasty without resection. The final three patients were treated with fundoplication alone. CONCLUSIONS: Barrett's esophagus can be caused by acid from gastric tubes but responds to H2 blockers and diet. Resection eliminates BE; esophagoplasty only controls the stricture and must be accompanied by fundoplication. Barrett's esophagus persists in patients with fundoplication alone if reflux control is incomplete. The authors conclude that acid reflux must be controlled to treat BE successfully or the involved segment must be resected. Esophagogastrostomy apparently predisposes to BE.     

咽结肠吻合治疗食管烧伤后瘢痕狭窄

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。     

Transhiatal esophageal resection for corrosive injury

OBJECTIVES: To analyze the feasibility and safety of transhiatal approach for resection of corrosively scarred esophagus. BACKGROUND SUMMARY DATA: The unrelenting corrosive strictures of esophagus merit esophageal substitution. Because of the risk of complications in the retained esophagus, such as malignancy, mucocele, gastroesophageal reflux, and bleeding, esophageal resection is deemed necessary. Transthoracic approach for esophageal resection is considered safe. The safety and feasibility of transhiatal resection of the esophagus is not established in corrosive injury of the esophagus. PATIENTS AND METHODS: Transhiatal approach was used for resection of the scarred esophagus for all patients between January 1986 and December 2001. The intraoperative complications, indications for adding thoracotomy, and postoperative outcome were studied in 51 patients. Follow-up period varied from minimum of 6 months to 15 years. RESULTS: Esophageal resection was achieved in 49 of 51 patients whereas thoracotomy was added in 2 patients. In 1 of the patients tracheal injury occurred whereas in other patient there were dense adhesions between tracheal membrane and esophagus. Gastric tube was used for esophageal substitution in 40 (78.4%) patients whereas colon was transplanted in 11 (21.6%) patients. Colon was used only when stomach was not available. One patient (1.9%) had tracheal membrane injury whereas 4 patients (7.8%) had recurrent laryngeal nerve palsy. One patient each had thoracic duct injury and intrathoracic gastric tube leak. There was no operative mortality. Anastomotic complications like leak were present in 19.6% and stricture in 58.8% patients. All the patients were able to resume their normal duties and swallow normal food within 6 months of the surgery. CONCLUSION: One-stage transhiatal esophageal resection and reconstruction could be safely used for the extirpation of scarred esophagus. Use of gastric conduit was technically simple, quicker, and offered good functional outcome. Postoperative anastomotic stricture amenable to dilatations was the commonest complication.     

“围巾式”食管-胃吻合术治疗食管下段静脉曲张出血

目的介绍“围巾式”食管－胃吻合术预防术后吻合口瘘的临床经验。方法回顾性分析2002年1月至2014年1月对75例门静脉高压症并食管下段静脉曲张出血病例行食管下段及胃底切除术时使用“围巾式”食管－胃吻合术治疗的结果。观察术后并发症发生率和病死率。结果75例手术无吻合口瘘发生,吻合口狭窄3例,术后复发出血2例,手术死亡1例。结论“围巾式”食管－胃吻合术可减少食管下段及胃底切除术后吻合口并发症,安全、有效。