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目的:手术治疗食管化学性灼伤后狭窄。方法:重建食管的手术方式包括间置结肠代食管术20例,胃代食管术2例,游离空肠移植代食管术7例,空肠部分带蒂加近端小血管吻合移植代食管术6例。结果:全组无手术死亡。间置结肠代食管术的并发症有颈部吻合口瘘4例,吻合口狭窄1例,颈部切口感染3例,粘连性肠梗阻2例,间置结肠蛔虫性穿孔致脓胸1例。空肠移植代食管术后有4例发生肠咽吻合口并发症,其中3例行肠咽吻合成形术恢复了患者的吞咽及语言功能,1例因喉部损伤严重,肠咽吻合口再狭窄反复发生吸入性肺炎,行喉气管—移植空肠吻合重建了食管通道。结论:间置结肠代食管术是治疗食管化学性灼伤后狭窄有效的外科治疗方法,空肠移植代食管术是治疗高位食管化学性灼伤后狭窄的首选方法。
Objective: Surgical treatment of esophageal chemical burns stenosis. Methods: The reconstructive esophageal surgical methods included intercostal esophageal surgery in 20 cases, gastric esophageal surgery in 2 cases, free jejunal transplation on behalf of esophageal surgery in 7 cases, jejunal partial pedunculated pedicle plus proximal small vessel anastomosis on behalf of the esophagus in 6 cases. Results: All patients died without surgery. The complications of intercostal esophagectomy included anastomotic fistula in 4 cases, anastomotic stenosis in 1 case, cervical incision infection in 3 cases, adhesive intestinal obstruction in 2 cases and interstitial ascaris perforation caused empyema in 1 case. There were 4 cases of enteropharyngeal anastomosis complications after jejunal transplantation on behalf of esophagus. Three cases underwent pharyngeal anastomosis to restore swallowing and language function. One case suffered from severe laryngeal injury and repeated re-enteral esophageal anastomosis Aspiration pneumonia occurs, and laryngotracheal-jejunostomy is performed to reconstruct the esophageal passage. Conclusion: The interpositional esophageal esophagus is an effective surgical treatment of stenosis after esophageal chemical burns. Esophagectomy with jejunal transplantation is the first choice for the treatment of stenosis after upper esophageal chemical burns.