Effects analysis of colon interposition for alimentary reconstruction after esophagectomy

doi:10.3877/cma.j.issn.2095-8773.2015.04.004

Abstract

Abstract:

Objective

To analyze the outcomes of colon interposition for alimentary reconstruction after esophagectomy.

Methods

The clinical data of patients undergoing esophagectomy in Shanghai Chest Hospital between June 1985 and June 2015 were reviewed. Colon interposition was performed in 107 of these patients, and the surgical indications, surgical techniques and early outcomes after operation were analyzed.

Results

Eighty-one patients(75.5%) were males. Malignance accounted for 58.9%(63/107), and corrosive injury 28.9%(31/107). The isoperistaltic left colon interposition with blood supply from the ascending branch of left colic artery was the predominant selection of colon transplantation, which accounted for 79.4%(85/107). The retrosternal approach was adopted in 91.6% of patients(98/107). A total of 95.4% of anastomosis(102/107) was in the neck. The mean in-hospital time after operation was (32±22) d (13-121 d). Anastmostic leak took place in 19.6% of patients(21/107), stricture in 8.4%(9/107), and interposed colon necrosis in 1.9%(2/107). The surgical mortality was 0.9%. The history of stomach operation and diabetes were the risk factors of leak.

Conclusions

Colon interposition is the mainstay of the complex esophageal reconstruction, and the morbidity and mortality are acceptable.

Key words: Colon, Alternatives, Esophagectomy, Esophageal caustic strictures

Rong Hua, Teng Mao, Heng Zhao, Wentao Fang, Wenhu Chen, Yu Yang, Xufeng Guo, Chenxi Zhong, Zhigang Li. Effects analysis of colon interposition for alimentary reconstruction after esophagectomy[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2015, 02(04): 227-231.

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Figures/Tables 4

References 11

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病因	例数(107例)	百分比(%)
恶性疾病	63	58.9
食管化学伤	31	28.9
食管非特异性狭窄(良性)	3	2.8
颈段食管损伤	6	5.6
胃代食管失败后挽救性手术	4	3.7

病因	例数(107例)	百分比(%)
恶性疾病	63	58.9
食管化学伤	31	28.9
食管非特异性狭窄(良性)	3	2.8
颈段食管损伤	6	5.6
胃代食管失败后挽救性手术	4	3.7

病因		例数(63例)	百分比(%)
胃手术后食管癌		28	44.4
食管旁路手术		12	19.0
?	肿瘤无法切除	8	12.7
?	直接切除肿瘤	4	6.3
食管或贲门癌术后吻合口复发		8	12.7
?	腺癌	3	4.8
?	鳞癌	5	7.9
食管癌术后再发癌		7	11.1
食管胃重复癌		2	3.2
颈段食管癌		2	3.2
早期食管癌保留胃		2	3.2
术中合并全胃切除		1	1.6
术中误伤胃网膜右血管		1	1.6

病因		例数(63例)	百分比(%)
胃手术后食管癌		28	44.4
食管旁路手术		12	19.0
?	肿瘤无法切除	8	12.7
?	直接切除肿瘤	4	6.3
食管或贲门癌术后吻合口复发		8	12.7
?	腺癌	3	4.8
?	鳞癌	5	7.9
食管癌术后再发癌		7	11.1
食管胃重复癌		2	3.2
颈段食管癌		2	3.2
早期食管癌保留胃		2	3.2
术中合并全胃切除		1	1.6
术中误伤胃网膜右血管		1	1.6

临床特征		吻合口瘘		合计	发生率(%)	χ ²值	P值
临床特征		有	无	合计	发生率(%)	χ ²值	P值
胃肠手术史		?	?	?	?	6.921	0.009
?	有	16	38	54	29.6	?	?
?	无	5	48	53	9.4	?	?
术前放化疗		?	?	?	?	6.942	0.022
?	有	7	9	16	56.3	?	?
?	无	14	77	91	15.4	?	?
糖尿病		?	?	?	?	8.457	0.010
?	有	8	10	18	44.4	?	?
?	无	13	76	89	14.6	?	?
吸烟史		?	?	?	?	0.311	0.861
?	有	8	31	39	20.5	?	?
?	无	13	55	68	19.1	?	?
病灶位置		?	?	?	?	1.552	0.829
?	颈段	2	17	19	10.5	?	?
?	上段	8	25	33	24.2	?	?
?	中段	6	24	30	20.0	?	?
?	下段	3	11	14	21.4	?	?
?	贲门	2	9	11	18.2	?	?
移植径路		?	?	?	?	0.454	0.502
?	食管床	1	8	9	11.1	?	?
?	胸骨后	20	78	98	20.4	?	?
供血结肠动脉		?	?	?	?	4.918	0.027
?	左	13	72	85	15.3	?	?
?	右	8	14	22	36.4	?	?
吻合位置		?	?	?	?	0.158	0.691
?	颈部	19	80	99	17.8	?	?
?	胸顶	2	6	8	1.9	?	?
吻合方式		?	?	?	?	0.050	0.823
?	机械	3	14	17	17.6	?	?
?	手工	18	72	90	20.0	?	?
对合方式		?	?	?	?	0.030	0.863
?	端侧	17	71	88	19.3	?	?
?	端端	4	15	19	21	?	?

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