The Clinical Study Of Upper Gastrointestinal Tract Reconstruction With Colon

The colon is the organ of choice to reconstruct digestive continuity because of its enough lengths for cervical esophagocolic anastomosis or pharyngocolonic anastomosis. The colon has long mesentery and excellent blood supply, constant vascular arcade; sufficient blood supply can be provided for the graft by one branch of the colic vessels. The transerve、ascending and descending colon are used based on the colic vessels, with a high successful rate. There are many potential advantages to the use of colon for esophageal reconstruction: first, the stomach still stays in its anatomical location, remaining the continuity of the digestive system, with a lower of inspiratory regurgitation and reflux than stomach; with strongly antacid comparing with jujnum. The colonic replacement of the esophagus is complex, with three anastomosis and special bowel preoperation preparation, and high complication rate, considering it is the key that studies on how to reduce the operative complications of colonic replacement of the esophagus, especial in the old man with esophageal diseases、esophageal stricture with throat damage, to increase the efficiency of surgery treatment. The present study was performed in three parts as following:Section One Esophageal replacement with colon in old patientsObjective To study the indications, perioperative management and surgical technique of esophageal replacement with colon (ERC) in old patients.Methods From June 1982 to June 2004,75 old patients underwent ERC procedure, including 45 males and 30 females, aging from 60 to 74 years old. The diseases type, operation method, selection of the colon segment, colon blood supply and pathway for pulling up of transplanted colon and postoperative complications were analysised. Results Postoperative complications occurred in 19 cases with 3 deaths, including anastomotic leakage in 16cases, respiratory complications in 10 cases, cardiac complications in 4 cases, anastomotic stenosis in 2 cases, injury of recurrent laryngeal nerve in 2 cases and pyemia in 2 cases. The 1,3,5 years survival rate were 83.9%,58.4%, and 30.9%, respectively and the 1,3,5 years survival rate of rechannel of esophagus were,53.0%,38.9%, and 16.1%, respectively. All the patients in the group of benign esophageal diseases survived well with normal lives and activities, after 1-10 years follow up.Conclusion Esophageal replacement with colon had more complications for treating esophageal diseases of old patients than young patients. There are several keys to amelioate the results and reduce the complications.The keys are insure the prefeterable blood supplying, easy and smooth of the route which the colon segment was pulled up to the neck and protable perioperative management.Section Two Effective measures reduce colonic segment ischemia and anastomotic leakage of esophageal replacement with colonObjective To explore the effective measures to reduce colonic segment ischemia and anastomotic leakage of esophageal replacement with colon (ERC).Methods Clinical data of 593 patients received ERC from March 1966 to December 2009 were analyzed retrospectively.Results Most of patients received ERC were diagnosed as esophageal cancer and esophageal stenosis.55.5%of cases underwent esophageal reconstruction and 44.5%of cases underwent esophageal bypass. During ERC procedure, the colon interposition graft length should be 3-4 cm longer than expectation; good blood supply was maintained；the lifted passage Was unobstructed, and the physiological peristalsisdirection was kept. The incidence of anastomotic leakage Was 11.8% in total patients,13.6% before 1996 and 6.4% after 1996. No intestinal ischemia was observed in all the patients.Conclusion When performing ERC, the main preventional managements of anastomotic leakage and intestinal ischemia are fully blood supply maintenance and intercepting enough length of the colon graft. Ensuring unobstructed passage is good for survival of the colon graft. Correct physiological peristalsis direction of colon interposition is beneficial to the healing of the anastomosis.Section Three Laryngic-colonic anastomosis for esophageal reconstruction in the treatment of caustic esophageal burns with severe pars laryngea pharyngis cicatricial constrictionObject To observe the experience and the outcome of laryngic-colonic anastomosis for esophageal reconstruction in caustic esophageal burns involving hypopharynx.Methods To retrospective 2 patients who underwent esophageal reconstruction by cololaryngostomy procedure, which making the larynx a part of the alimentary tract.Results The patients were cured and leave hospital in 3-weeks after operation. With a follow-up period ranging from 3～6 months, they started to gain weight.Conclusion Applying laryngic-colonic anastomosis for esophageal reconstruction is shown to be safe and effective. In this procedure, the larynx was used for the integrity of the gastrointestinal system.