胃大部切除术后胸内横结肠间置的临床应用

目的 探讨胃大部切除术后食管下段癌和贲门癌术后局部复发的消化道重建方式。方法 从1999年3月至2001年12月，手术治疗3例胃大部切除术后食管下段癌、3例贲门癌术后吻合口局部复发、1例胃癌侵犯食管下段的患。均采用横结肠以逆蠕动方式作胸内间置，间置结肠置于食管床。食管结肠吻合均在主动脉弓下缘水平完成。结果7例患的肿瘤都得到了完全切除，无切端阳性记录。本组无结肠坏死和吻合口瘘发生。1例术后2周死于肺部感染、呼吸衰竭，2例术后早期有进食时呃逆和轻度反流，余均达到满意效果。随访9～38个月，1例9个月后死于肿瘤广泛转移；1例术后15个月至今存活；4例术后生存2年以上，其中1例至今已生存38个月。结论 对于胃大部切除术后的食管下段癌和贲门癌术后局部复发等疾病的治疗，胸内横结肠间置是一种相对简单而又安全可靠的消化道重建方法。

Clinical application of transverse colon interposition for esophageal replacement

Objective To explore the approach of alimentary reconstruction in patients with lower esophageal cancer after gastrectomy and postoperative local recurrence of cardiac cancer. Methods From March 1999 to December 2001,7 patients underwent intrathoracic colonic replacement for esophagus for lower esophageal cancer after gastrectomy(n=3), postoperative recurrence of cardiac cancer(n=3), stomach cancer involving lower esophagus(n=1).The segment of transverse colon was placed in antiperistaltic pattern and in esophageal bed, and the anastomosis between esophageal remnant and transplanted colon was performed below the aortic arch. Results Tumors were totally resected in all 7 patients. No positive margin was found. There was no necrosis of transplanted colon and anastomotic leakage. One patient died of pulmonary infection and respiratory failure two weeks after operation. Two patients had little regurgitation at early stage, and others had good functional results. One patient died of extensive metastasis 9 months after surgery, 1 was alive for 15 months, 4 survived for more than 2 years after surgery, one of which had been alive for 38 months so far. Conclusions Intrathoracic interposition of transverse colon for esophageal replacement can be used in patients with lower esophageal cancer after gastrectomy and postoperative local recurrence of cardiac cancer. The procedure is comparatively simple, and good functional results can be expected.