胸结肠综合征的病因及治疗

目的 探讨结肠代食管术后远期发生的移植结肠段排空障碍、过度扩张综合征的病因及防治方法。方法 1962—1999年548例结肠代食管手术病例，425例获得随访，发现符合此征者9例，均为20世纪70年代手术病例。结果 9例中结肠胃吻合口过大者5例，结肠袢腹段冗长成角者2例，器质性梗阻2例。有7例经再手术治愈；另2例经药物治疗症状缓解。20世纪80～90年代手术病例均未再发生此征。结论 此征的病因为结肠胃吻合口过大，结肠腹段冗长成角或发生器质性狭窄。防治方法为术中保持结肠胃吻合口直径为肠腔内径的1／2—2／3，并加施抗反流术；已作迷走神经干切断者宜加作幽门括约肌成形术。

Etiological factors and treatment for thoracic colon syndrome

Objective: To investigate the etiological factors and treatment for a rare evacuation disturbance and severe dilatation syndrome of transplanted colon for esophagus diseases. Methods: From 1962 to 1999, 548 patients with colon replacement for esophagus were studied. 425 patients were followed-up for 0 5 to 10 years. 9 patients with thoracic colon syndrome were operated on from 1970 to 1980. The clinical sign, experiment test, etiological factor and method of treatment were reviewed. Results: 5 patients had large anastomotic stoma of colon-stomach, 2 had angulation of abdominal part colon, and 2 had mechanical obstruction. 7 patients were cured after reoperation. Clinical symptoms of other 2 patients were remission after drug treatment. No thoracic colon syndrome occurred after 1980. Conclusion: The etiological factors of thoracic colon syndrome were too large colon-stomach anastomotic stoma, angulation of long-winded colon in abdomen part colon and mechanical obstruction. Colon-stomach stoma should be 1/2 to 2/3 of intestinal luminal diameter and anti-reflux operation should be done at the same time. The pyloroplasty is essential when truncal vagotomy has been done during the operation.