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Treatment of special types of esophageal replacement with colon esophageal cancer


Pull off the esophagus without thoracotomy, colon esophagus, postoperative survival of patients had more than 1O years. 3 Discussion 3.1 Evaluation of surgery of esophageal replacement with colon highlight the advantages of their home after anastomosis between the stomach and colon did not meet the physical movement, and the colon is long and straight, the bow close to the intestinal vascular edge of constant growth, a good blood supply after transplantation can be raised to the neck or on the hypopharynx fit, do not kiss then blood vessels, colon mucosa secretions is alkaline, acid capacity, therefore, is commonly used in surgical procedures on behalf of one of the esophagus, in particular, has been in gastrectomy for postoperative esophageal cancer patients, is the preferred method of esophageal reconstruction. Esophageal replacement with colon surgery,[link widoczny dla zalogowanych], but the disadvantage of heavy pollution than the esophageal lumen diameter large diameter, high incidence of infection, the incidence of anastomotic leakage is higher, a few cases when transplanted to match the hypopharynx may be due to long distance, tension is failed. In the past 1O years of the colon esophageal reconstruction has made significant progress, Cheng Bangchang ... summary of 260 cases of esophageal replacement with colon surgery experience, the surgical success rate of 96.91%, 21.53% complication rate, mortality rate 2.3% that of patients with indications for this surgical application should be. There were no graft necrosis colon segment, the success rate of 100%. Zero mortality and complications are significantly reduced compared with the early results were satisfactory. Author: Jiyuan City, Henan, 454650 People's Hospital of Thoracic Surgery (Qiao Baoan); Shanghai Changzheng Hospital, Thoracic Surgery (Sun Yaochang) 3.2 blood vessels nourish the colon and the choice of the left colon 【2】 The artery was transplanted blood vessels nourish the colon segment should be the preferred The groups were selected as the pedicle of the left artery of colon nourishing blood vessels, plus some of the right colon transverse colon by retrosternal transplanted to the neck; arteries to nourish the blood vessels in the colon, with the terminal ileum, cecum, ascending colon and transverse colon right colon organ transplantation, its advantages are creeping along, the ileocecal valve cardia have a similar effect, to avoid reflux in children apply this surgical patients better 【3】. 3.3 Prevention of complications of anastomotic leakage is still neck and colon is one of serious complications of esophageal surgery, the occurrence rate of 15.7% ~ 43.7%, anastomotic leakage in this group 2 patients, the occurrence rate of 15 %, also higher. Following the occurrence of fistula prevention and treatment of several measures: ① bowel transplantation must be of sufficient length, tension-free anastomosis to the left colonic artery for the vascular pedicle is better nourished. Intestine from the stomach into the lesser sac behind the chest to avoid the oppression of Helicobacter mesangial, vascular arcades to ensure integrity, no tension, a good blood supply; ② substernal tunnel should be loose,[link widoczny dla zalogowanych], to prevent intestinal transplantation in the chest pressure, venous return edema caused bad blood circulation disorders, the colon will be put into plastic bags in the intestine, coated with paraffin oil,[link widoczny dla zalogowanych], slowly pull up to prevent vascular injury mesangial; ③ inconsistent with colon and esophageal caliber, easy to make the film on the aggregate non-performing, the group end anastomosis are used, a small-caliber esophagus oblique incision possible expansion, anterior mucosa using absorbable suture continuous suture on the mucosal muscular layer interrupted suture syrup addition, to ensure a good film on the aggregate, less satisfied or contamination of the agreement in recent years by severe Phase II neck incision suture method for preventing infection caused fistula. Some scholars believe that cervical esophagus, colon anastomosis with a layer of better than two anastomosis suture does not occur because the muscle layer of distortion, mild inflammation and promote healing. We realize the key to success is the blood supply of the colon, and mucosal venous drainage of the joint is better to light pollution. ④ full bowel preparation before surgery is important to reduce contamination of consistent measures, our hospital the afternoon before surgery 1 oral mannitol 1000ml, metronidazole 0.4g,[link widoczny dla zalogowanych], 1,2,3,6,9,[link widoczny dla zalogowanych], each serving a 1, Kanamycin cable 0.5g, 1,2,3 and 1 times, observe the stool frequency to clear up until 3 days before surgery eating liquid, 1 enema every night. Using this method to prepare more thoroughly clean the intestinal tract. Anastomosis stenosis is a common complication of this procedure. The group 2 patients had cervical anastomotic stenosis after angioplasty by platysma flap, 1 case of stenosis by angioplasty without infection (longitudinal open transverse) were cured. Esophageal stump or the front side with bevel cut was Formation is mucosal involution important way to combat narrow. This group of mucosal anastomosis with anterior mucosal anastomotic stricture rate was not high, one of the reasons.
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