CAJ | 학술논문

目的:探讨下咽、食管肿瘤及狭窄病变切除后,采用胃上提结肠上徙进行食管重建的手术适应证和术后并发症.方法:回顾性分析行胃上提咽胃吻合52例、结肠上徙咽结肠吻合66例患者的临床资料,其中肿瘤组87例,行胃上提52例,结肠上徙35例;下咽食管腐蚀性狭窄和闭锁组31例,均行结肠上徙食管重建.结果:肿瘤组胃上提52例中保留喉功能28例;结肠上徙35例中保留喉功能18例,选择不同的食管修复方法对喉功能保留无明显影响(P>0.05).但结肠上徙组咽瘘发生率25.8%(17/66)明显高于胃上提组9.6%(5/52)(P<0.05).胃上提组胃液反流发生率30.8%(16/52)明显高于结肠上徙组4.5%(3/66)(P<0.05).结论:胃上提结肠上徙食管修复术可以在彻底切除下咽、颈段食管肿瘤的同时,保留部分患者的喉功能.由于胃上提患者术后胃液反流的发生率较高,且吻合口位置较高,对保留喉功能的下咽或食管肿瘤临床上仍主张采用结肠上徙修复.但由于结肠血液供应不如胃组织丰富,咽-肠吻合口瘘的发生率较高.
목적:탐토하인、식관종류급협착병변절제후,채용위상제결장상사진행식관중건적수술괄응증화술후병발증.방법:회고성분석행위상제인위문합52례、결장상사인결장문합66례환자적림상자료,기중종류조87례,행위상제52례,결장상사35례;하인식관부식성협착화폐쇄조31례,균행결장상사식관중건.결과:종류조위상제52례중보류후공능28례;결장상사35례중보류후공능18례,선택불동적식관수복방법대후공능보류무명현영향(P>0.05).단결장상사조인루발생솔25.8%(17/66)명현고우위상제조9.6%(5/52)(P<0.05).위상제조위액반류발생솔30.8%(16/52)명현고우결장상사조4.5%(3/66)(P<0.05).결론:위상제결장상사식관수복술가이재철저절제하인、경단식관종류적동시,보류부분환자적후공능.유우위상제환자술후위액반류적발생솔교고,차문합구위치교고,대보류후공능적하인혹식관종류림상상잉주장채용결장상사수복.단유우결장혈액공응불여위조직봉부,인-장문합구루적발생솔교고.
Objective:To evaluate the surgical indications and postoperative morbidity of pharyngogastric anastomosis or pharyngocolonic anastomosis in esophageal reconstruction for advanced hypopharyngeal and cervical esophageal neoplasms or diffuse corrosive hypopharyngoesophageal stricture.Method:Retrospectively analysis the experience and results of 52 patients undergoing esophageal reconstruction with pharyngogastric anastomosis and 66 patients with pharyngocolonic anastomosis. In the group of neoplasms, total esophagectomy with pharyngo-gastric anastomoses in 52 cases and with pharyngo-colonic anastomosis in 35 cases. Thirty-one cases with diffuse corrosive hypopharyngoesophageal stricture were treated by pharyngo-colonic anastomosis without resection of the strictured intrathoracic esophagus.Result:In the group of neoplasms, preservation of laryngeal functions in pharyngogastric anastomoses was performed in 28/52 cases and that of in pharyngo-colonic anastomosis was in 18/35 cases. There was no significant difference in preservation of laryngeal functions between two groups(P>0.05). Pharyngocutanuous fistula was happened in 23 patients which significant higher in the group of pharyngocolonic anastomosis (17/66 cases) than that of pharyngogastric anastomoses (5/52 cases) (P<0.05). Gastric reflux was presented in 19 cases and there was significant higher in pharyngogastric anastomoses(16/52 cases) than that of(3/66 cases) (P<0.05).Conclusion:Substitution of esophagus with stomach or colon can completely removed the neoplasms of hypopharynx or cervical esophagus and preserved laryngeal functions in selected patients. But gastric reflux is a challenging reconstructive problem in pharyngogastric anastomosis. Pharyngocolonic anastomosis should take into consideration to patients with extensive neoplasms and diffuse corrosive stricture or probably preserved the laryngeal functions. However, the swallow function is weak and the incidence of pharyngocolonic fistula is higher than that of pharyngogastric anastomosis.