| 摘要: |
| 目的：总结结肠代食管术在食管切除消化道重建中的方法及经验。方法：回顾分析我科在2011.3-2014.3行结肠代食道术20例患者的临床资料。17例行右胸、腹正中及左颈部三切口术式,结肠上提路径均为胸骨后通道,颈部切口采用切除左半侧胸骨柄及左侧胸锁关节和第一胸肋关节,其中12例采用胸腔镜辅助；3例行右胸腹两切口术式。结果：无围术期死亡；术后颈部吻合口瘘2例,腹腔肠瘘2例,肠梗阻2例,声音嘶哑5例,肺部感染5例,共发生于7例患者,并发症率为35%；全组无间置结肠全段缺血坏死病例；随访1-4年,死亡1例,肿瘤远处转移2例。结论:对于需要行长段食管重建而不能使用胃代食管的患者,结肠代食道术仍是较好的选择；胸腔镜辅助胸腔操作可减少手术创伤；切除左半胸骨柄、左侧胸锁关节及左侧第一胸肋关节的颈部切口有利于胸骨后通道的建立,可减少颈部吻合口瘘的发生,并有利于瘘的愈合。 |
| 关键词: 食管肿瘤 结肠代食管术 胸腔镜检查 淋巴结切除术 |
| DOI：10.16781/j.0258-879x.2016.04.0524 |
| 投稿时间：2015-10-11修订日期：2015-12-23 |
| 基金项目: |
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| Esophageal replacement with colon: a clinical experience with 20 cases |
| LU Chao-jing,CHEN He-zhong,YANG Li-xin* |
(Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective: To summarise the Clinical experience of esophageal replacement with colon after esophagectomy. Methods: Reviewed the clinical data of 20 patients who underwent esophageal replacement with colon between March 2011 to Mach 2014. 17 patients underwent 3 incisions esophagectomy, colon was extracted behind the sternum, resected the left-half manubrium sterni, left sternoclavicular joint and the first sternocostal joint for the cervical incision; 12 operations were assisted by the thoracoscopy. 3 patients underwent open two-field esophagectomy through right thoracoabdominal incision.Results: No perioperative death. 2 cases with anastomotic leakage of cervical, 2 cases with intestinal fistula, 2 cases with intestinal obstruction, 5 cases with hoarseness, 5 cases with pulmonary infections; the complication rate was 35% (n=7). No ischemic necrosis in the whole section of the interposed colon. Follow up for one or four years, 2 deaths, 2 distance metastasis.Conclusion: For the patients who need the reconstruction of the esophagus but the stomach is unavailable, the better option for the replacement is the colon. Assisted by the thoracoscopy could reduce the surgical trauma. Resecting the left-half manubrium sterni, left sternoclavicular joint and the first sternocostal joint for the cervical incision is helpful for the construction of the substernal pathway, reduction of the anastomotic leakage, and the healing of the fistula. |
| Key words: esophageal neoplasms esophageal replacement with colon thoracoscopy lymph node excision |
