食管重建在食管瘢痕狭窄手术中的应用

目的 总结食管重建治疗食管瘢痕狭窄的临床经验。方法 106例采用保留结肠左动脉升支、胸骨后横结肠代食管、顺蠕动吻合，其中横结肠咽腔吻合32例，横结肠食管颈部吻合74例；22例采用胸骨后胃咽腔或胃食管颈部吻合。结果 无手术死亡。术后颈部吻合口瘘13例、吻合口狭窄9例、气管切开3例，经治疗后进食均顺利。结论 食管瘢痕狭窄的治疗应积极采取食管重建术，食管替代物中以横结肠为佳，重建平面需在颈部或咽部，不主张切除瘢痕食管。

Esophageal reconstruction for cicatricial esophageal stenosis

Objective] To review the experience of surgical management in treating 128 cases with cicatricial esophageal stenosis by esophageal reconstruction. Methods] 106 cases with cicatricial esophageal stenosis were treated surgically, in whom 32 underwent colophargageal anastomosis and 74 esophagocologastrostomy. The ascending branch of the left artery of the transverse colon was preserved as the supporting vessel of the interpositioned colon. 22 cases with cicatricial esophageal stenosis were treated surgically with esophagogastrostomy in the neck or pharynx. Results] There was no death involved in the operation. The leakage of cervical anastomos occurred in 13 cases,anastomosis stenosis in 9 cases, and tracheotomy was performed in 3 cases. All cases were perfectly recovered by the treatment. Conclusion] Esophageal reconstruction with transverse colic interposition by esophagocologastrostomy or colonphargaged anastomosis is an optimal opproach to the treatment of caustic esophageal stricture. Transverve colon is an ideal substitute for the replacement of the whole esophagas.