结肠代食管术后远期并发症的观察

目的 探讨结肠代食管术治疗食管良性疾病远期并发症的病因和防治措施。方法577例结肠代食管术中良性疾病组123例,术后106例（86％）随访1～28年。其中11例出现（25例次）严重并发症：结肠冗长、扩张12例次,吻合口重度狭窄4例次,食管巨囊状变2例次,结肠胃吻合口过大4例次,肠段梗阻3例次。根据病变采取狭窄区成形或切除、冗长肠段切除重建、梗阻区松解、吻合口切除重建。结果 经1次手术矫治8例,2次手术2例,3次手术1例。术后恢复正常饮食者9例（9／11）,进食明显改善者2例（2／11）。结论 食管良性疾病结肠代食管术后远期并发症的病因归属于医源性和功能性两大类,其预防措施为术中注意：颈部食管-结肠吻合口〉2．5cm,腹段结肠-胃吻合口加抗反流术,结肠上提通道宽畅无阻,肠管拉直;对出现局限性狭窄或肠段扩张、冗长排空不畅,再次手术矫治为最佳选择。

Observation on the long-term complications after esophageal replacement with colon

OBJECTIVE: To study the etiology and preventive measures of the long-term postoperative complication after esophageal replacement with colon for esophageal benign disease. METHODS: To review the clinical data of 577 patients with esophageal replacement with colon our department, including 123 cases of esophageal benign disease. Of all, there were 25 cases-time for 11 cases following with severe complication: redundancy and dilated colon 12 cases-time, severe stricture of stoma 4, macrocyst esophagus 2, colon-stomach stoma expansion 4, mechanical obstruction of colon 3. The etiology included iatrogenic and functionality. The therapy included stricture form or resection, redundancy segment resection, obstructed segment solution and stoma resection and form. RESULTS: Eight cases underwent once operation, 2 case twice, 1 case three times. After operation, 9 cases took food normally, 2 improved symptoms obviously. CONCLUSIONS: The iatrogenic and functionality factor contributed to severe complication after esophageal replacement with colon for esophageal benign disease. The preventive measure is followed during operation: cervical esophageal-colon anastomosis exceed 2.5 centimeter, abdominal colon-stomach anastomosis reflux, channel width of colon passage, intestinal canal lay up straight. Re-operation is best choice to for local stricture, colon expansion, redundancy and dilated colon.