回结肠代食管术34例临床分析

摘要

目的 探讨回结肠代食管术的安全性和有效性.方法 回顾性分析2015年7月至2017年11月上海交通大学附属胸科医院胸外科连续施行的34例回结肠代食管术患者的临床资料.男性24例,女性10例,年龄7~72岁.采用结肠右动脉和(或)结肠中动脉作为供血管,经胸骨后径路行回结肠代食管(1例患者采用经皮下径路).统计围手术期并发症发生率及术后生活质量.结果总体并发症发生率为23.5%(8/34),围手术期颈部吻合口瘘发生率为5.9%(2/34)、移植结肠坏死发生率为5.9%(2/34).2例患者因移植结肠坏死、1例患者因肠梗阻接受再次手术,其中1例结肠坏死患者死于二次手术后感染性休克,总体病死率为2.9%.远期并发症包括颈部食管?回肠吻合口狭窄6例、腹泻2例.截至2017年12月,随访1~28个月,中位随访时间9个月,1例死于食管癌术后复发转移,余32例存活.结论 采用结肠右动脉和(或)结肠中动脉作为供血管、经胸骨后径路回结肠代食管术较为安全有效,简单易行.%Objective To evaluate the safety and effectiveness of esophageal replacement with ileocolon graft. Methods Totally 34 cases of esophageal replacement with ileocolon graft from July 2015 to November 2017 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University were analyzed retrospectively,including 24 male and 10 female, aging from 7 to 72 years old. Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route except one subcutaneous route. The primary esophageal disease,postoperative complication rate and quality of life were analyzed. Results The overall postoperative complication rate was 23.5%(8/34), cervical anastomotic leakage rate of 5.9%(2/34),necrosis of colon graft of 5.9%(2/34). There were 3 patients experienced re?operation including 2 patients with colon graft necrosis and 1 patient with intestinal obstruction after ERC. 0ne patient with colon graft necrosis died of septic shock after reoperation. Six cases of cervical esophago?jejunal anastomosis stenosis and 1 case of diarrhea occurred in the later time. All patients were followed up for a median time of 9 months(range:1 to 28 months),32 cases survived but 1 patient died until last follow?up by the end of December 2017. Conclusion Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route was safe and effective.