CAJ | 학술논문

食管切除后常用胃或结肠来进行重建，但对于一些病变位置过高、合并胃或结肠病变、胃或结肠已做过手术、局限性严重食管狭窄患者，可选择其他方法重建或修复。能用于修复及重建食管皮瓣、肌皮瓣有十余种，根据血供来源分为游离皮瓣及带蒂肌皮瓣。游离皮瓣需血管吻合，一旦出现血管阻塞，易发生皮瓣坏死，以选择带蒂肌皮瓣修复及重建食管为宜。胸大肌皮瓣及背阔肌皮瓣尽管血运丰富，但肌皮瓣臃肿，且难以形成管状重建全周食管。颈阔肌皮瓣面积大，多源性血液供应，单侧可用于修复颈段食管缺损，双侧能重建全周颈段食管，手术操作简便，疗效可靠，长期随访皮瓣无溃疡及毛发生长，且能耐受放疗，值得推广应用。
식관절제후상용위혹결장래진행중건，단대우일사병변위치과고、합병위혹결장병변、위혹결장이주과수술、국한성엄중식관협착환자，가선택기타방법중건혹수복。능용우수복급중건식관피판、기피판유십여충，근거혈공래원분위유리피판급대체기피판。유리피판수혈관문합，일단출현혈관조새，역발생피판배사，이선택대체기피판수복급중건식관위의。흉대기피판급배활기피판진관혈운봉부，단기피판옹종，차난이형성관상중건전주식관。경활기피판면적대，다원성혈액공응，단측가용우수복경단식관결손，쌍측능중건전주경단식관，수술조작간편，료효가고，장기수방피판무궤양급모발생장，차능내수방료，치득추엄응용。
Stomach and colon are always used to reconstruct esophagus after esophagectomy. However, alternative procedures to reconstruct or repair esophagus are required if the patients suffered from gastric or colonic diseases, underwent gastric colonic operations or had severe local esophageal stricture. More than ten kinds of skin flaps and myocutaneous flaps, which are classified into free or pedicled ones, are used to reconstruct or repair esophagus. Microvascular anastomosis is required while using free flaps. Necrosis of the free flaps is prone to developing once the vascular occlusion occurs. The pectoralis major myocutaneous and latissimus dorsi pedicled flaps have sufficient blood supplies. However, both are bulky and difficult to reconstruct a circumferential esophagus through contouring a tube. Platysma myocutaneous flaps have a large surface area and are supplied from multiple vessels. Single lateral and bilateral platysma myocutaenous flap can be applied to repair the cervical esophageal defect and circumferential cervical esophagus, respectively. The use of platysma myocutaneous to repair and reconstruct cervical esophagus is a procedure easy to perform and confer excellent outcomes. There is no development of ulcer and hair growth after long-term follow-up and resistance to radiotherapy.