胸锁关节切除治疗小儿结肠代食管术后胸腔出口梗阻的应用

目的探讨胸锁关节切除在治疗小儿结肠代食管手术后胸腔出口处结肠襻梗阻的疗效。方法本组1997年8月～2006年3月,收集我科及南方医院胸外科共行前纵隔入路结肠代食管手术39例。其中,儿童11例,出现胸腔出口处结肠梗阻3例,均需再行胸锁关节切除,解除梗阻。结果3例儿童均经再行左侧胸锁关节切除后解除梗阻而治愈。结论运用结肠经前纵隔入路重建食管,若手术探查中发现有胸骨柄向下凹陷,胸锁关节对吻合口以下结肠襻容易压迫而形成梗阻时,即应果断切除胸锁关节甚至部分胸骨柄,以避免术后发生吻合口以下结肠襻梗阻。

Application of sterno-clavicular joint resection for treating thoracic exit obstruction after esophageal replacement with colon in children

Objective To investigate the effect of sterno-clavicular joint resection for treating thoracic exit obstruction after esophageal replacement with Colon(ERC)In children Methods From August 1997 to March 2006,39 Cases underwent esophagus replacement with colon via premediastinum approach.Among them,colonic obstruction of thoracic exit was occurred in 3 of 11 children cases after operation,which sterno-clavicular joint resection was need for releasing obstruction.Results 3 cases with colonic obstruction of thoracic exit were cured after reoperation of left sterno-clavicular joint resection.Conclution In the course of esophageal reconstruction with colon via premediastinum approach,if finding out depression of presternum,the sterno-clavicular joint,even part of presternum should be resected for avoiding occurrence of colonic loop obstruction under anastomotic stoma.