结肠代食管术在老年人食管疾病中的应用

目的探讨老年人结肠代食管术的适应证、手术关键技术及围手术期处理。方法回顾性分析75例结肠代食管术患者的疾病病种、手术种类、肠段移植情况和供血管的种类及围手术期处理等。结果75例中,食管恶性病变66例,食管根治性切除63例,另3例及食管良性病变9例行食管改道术。顺结肠蠕动方向移植65例,逆蠕动向移植10例。结肠段经胸骨前皮下上提16例,前纵隔通道上提56例,后纵隔食管床3例。术后30 d内,有19例发生并发症,共36例次,死亡3例,手术死亡率4.0%。恶性食管疾病患者有53例术后随访1～5年,食管癌切除组1、3、5年生存率分别为83.9%、58.4%和30.9%;食管改道组分别为53.0%、38.9%和16.1%。食管良性疾病患者获随访者8例,1～10年均恢复正常生活、工作。结论严格控制老年人结肠代食管术的手术适应证,加强围手术期处理、术中注意选择适宜供血管及结肠段上提径路,可取得满意的临床效果。

Esophageal replacement with colon in elderly patients

Objective To investigate the indications,perioperative management and surgical technique of esophageal replacement with colon (ERC) in elderly patients.Methods From June 1982 to June 2004,75 elderly patients underwent ERC procedure,including 45 males and 30 females, aged from 60 to 74 years.The disease type,operation method,selection of the colon segment,colon blood supply and postoperative complications were analyzed.Results Postoperative complications occurred in 19 cases with 3 deaths,including anastomotic leak in 16 cases,respiratory complications in 10 cases,cardiac complications in 4 cases,anastomotic stenosis in 2 cases,injury of recurrent laryngeal nerve in 2 cases and pyemia in 2 cases.The 1,3,5 years survival rates in patients who underwent resection of esophageal carcinoma were 83.9%,58.4%,and 30.9% respectively and the 1,3,5 years survival rates of rechannel of esophagus were 53.0%,38.9%,and 16.1% respectively.All the 8 patients in the group of benign esophageal diseases survived well with normal lives and activities,after 1-10 years follow up.Conclusions Control of indications,optimizing perioperative management and surgical technique can reduce the complications and amelioate the results.