23例结肠代食管手术分析

目的:探讨结肠代食管手术在胸外科的应用。方法:自1984年6月至1995年11月,为23位病人行结肠代食管术24例次。其中腐蚀性食管灼伤19例(其中二次用结肠代食管术1例);先天性食管狭窄2例,均胸骨后途径,食管结肠颈部端侧吻合术;食管胸中下段癌既往胃大部切除史者1例,行颈、左胸、腹部三切口,行肿瘤切除、胸骨后途径,结肠端端吻合术;贲门癌术后吻合口复发1例,行二期手术,一期行肿瘤切除,空肠造瘘加强营养,二期胸骨后途径,食管结肠端端吻合术。结果:无手术死亡,吻合口瘘4例;移植段全结肠坏死2例;喉返神经损伤1例;幽门不全梗阻1例;气胸1例。结论:手术并发症多,应谨慎选择病例;加强围手术期管理能减少术后并发症,移植肠段的选择应由肠管血运决定。

Analysis of Replacement for Esophagus with Colon (A report of 23 cases)

objective: To stndy use of colonic interposition in the thoracic surgery. Methods :From January 1984 to November 1995,23 cases were performed interpostion of colon for 24 operatrons. There were caustic stricture of esophagus in 19 cases, one of them was operated twice. Congenital esophageal stenosis in 2 cases. A patient witt carcinoma of esophagus was previouly performed subtotal-gastrectomy. One case was recurrence of postoperative carcinoma of gastric cardia. Results: No intraoperative death occurred. There were following comlications: fistula of anastomosis in 4 cases;colon necrosis in 2 cases pyloric; obstruction in 1 case;Pneumothorax in 1 case. Conclusion:There are many complications of the colonic interposition operation,the cases are chosen strictly. For reducing the complications perioperative management must be intensified. The choice of interpotion of colon must be made according to blood supply of the colon.