结肠代食管术的并发症及其防治

分析２６０例结肠代食管病例资料，早期１００例的并发症率为３９％，近期１６０例并发症率为‘１０．６２％。重点探讨结肠段坏死、吻合口瘘或狭窄、喉返神经损伤、肠道梗阻、胸结肠综合征及食管盲囊综合征等并发症的原因，其防治措施。作者认为，改进结肠代食管术式是降低并发症的关键。

Management of Complications in Colon Replacement for Esophagus

ln order to find out the incidence,treatment and prevention of post colonic replacement for esophagus ,analy- ses of the clinical materials of 260 such cases were performed .The results showed that in the early 100 cases,the postoperative marbidity rate was 39% and it declined to 10.6% in the later 160 cases.The overall mortality was 2.30%.The potoperative complications in the early and late cases consisted of ledkage of cervical anastomosis (28vs8),recurrent nerve injury(3vs1), intestinal obstruction (3 vs0),respiratory failure(2 vs 1),septicemia(2 vs0),anastomosis stenosis (2 vs2),thoracic aolon syndrome(3vs2),blind esophageal pouch syndrome (2vs1)and others (2vs2).The measures taken for preventing colon necrosis were preservation of good colon blood supply with satisfactory blood pressure,avoidance of urdue pressure on and twisting of the colon segment.For reduction of cervical anastomosis leakage,good blood supply, proper one stitch whole layer anastomosis,iso-peristaltic anastomosis without obstruction,minimal contamination of the operative field and adequate gastricdecompression are essential measures to be taken.Laryngeal nerve injury can be avoided by gentle surgical technique withgood visualization and adequate auatomical knowledge.In ln preventing postoperative intestinal obstruction ,attention must be paid to the choice of the route through which the colonic segment was pulled up to the neck.IN case of pregastric route,a dumb-bell stomach can occur if the colon segment is too tightly pressing the stomach ; the colonic segment may be pinched by the rectus muscle or the tight diaghram.Intestinal obstruction can also caused by intestinal hernia through the not tighltyclosed mesenteric incision.Technical precautions should be taken to avoid the causes enlisted above .Cervical anastomosis stenosis is usually the result of healing of anastomosis leakage by scar formation of the long-term result of corrosive injury of the adjacent esophagus .During operation,the damaged part of the esophagus should be thoroughly resected before anastomosis starts .Thoracic colon syndrome is commlonly produced by:(1)too big anastomosis orifice,(2)anastomosis site too close to the pylorus,(3)angulation of the long intra-abdominal colon segment ,(4)hypertrophic stwenosis of pylorus.Modification of theanastomosis techniques to correct the above enlisted items is the answer of prevention .In severe cases,however,reoperation is necessary .Esophageal pouch syndrome is the clincal manifestation of mucus accumulation in the exteriorized blind esophageal pouch.Preventive measures include(1)avoidance of end to side anastomosis,(2)rsection of the pathological part of the esophagus at one situ,(3)complete destruction of the mucosa of the exteriorized part of the esophagus.Early resection of the esophageal pouch may be mandatory in severe cases.The authors conclude the incidence of complications of esophageal re- placement with colon can be reduced,and proper management including surgical intervention must be considered when clinical situations require.