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目的探讨带蒂空肠移植重建食管血供保护的有效措施。方法采用循证医学回顾性研究方法,分析了1998年至2006年采用带蒂空肠移植重建食管11例治疗颈段食管癌术式和移植肠管的血供保护措施。结果术后获1～5年随访,11例移植空肠全部成活,无发生缺血坏死,无吻合口瘘及狭窄发生。全组无手术死亡。结论保证空肠段和吻合口充分血供的有效措施为:①空肠段边缘血管弓完整、无张力、供血充分;②吻合口血管通畅;③空肠段上提通道宽畅;④保持围术期稳定的动脉压(60 mmHg以上);⑤采用全层缝合术;⑥采取综合性保护措施,改善患者全身营养代谢状况。
Objective To explore the effective measures of protecting the esophageal blood with reconstruction of pedicled jejunum. Methods Evidence - based medicine retrospective study was conducted to analyze the blood supply protection measures of esophageal carcinoma of the cervical segment and transplanted intestine in 11 patients with esophageal reconstruction using the pedunculated jejunum from 1998 to 2006. Results All patients were followed up for 1 to 5 years. Eleven cases of allograft jejunum survived. No ischemic necrosis occurred. No anastomotic fistula or stenosis occurred. The whole group died without surgery. Conclusion The effective measures to ensure sufficient blood supply to the jejunum and anastomosis are as follows: ① The bow of the jejunum segment is intact with no tension and blood supply; ② The anastomotic vessels are smooth; ③ The jejunal segment is smooth; ④ The perioperative stable Arterial pressure (60 mmHg above); ⑤ full-thickness suture; ⑥ take comprehensive protection measures to improve the patient’s nutritional status of the body.