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KMID : 0371319710130030101
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Journal of the Korean Surgical Society
1971 Volume.13 No. 3 p.101 ~ p.107
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A Clinical Study of Esophageal Reconstruction
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姜信學/Kang, S.H.
鄭相鳳/李章博/崔鳳洛/朴永寬/李鐵/Chung, S.B./Lee, J.B./Choi, B.R./Park, Y.K./Lee, C.
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Abstract
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This study consist of a clinical study of 48 cases of esophageal obstruction from either benign
caustic burn or malignant lesion treated by surgery, mainly subcutaneous or substernal colon
replacement.
These were all treated at the department of surgery, Presbyterian Hospital, Taegu, Korea from
January 1965 to December 1969. The age and sex distribution of these cases and the patient´s
motives of having swallowed caustic materials in cases of caustic esophageal stricture have all been
analysed, and discovered that most of their age range was between 21∼30 years of age, and the
sex ratio was 2:1 being the female predominant. There was 4 cases of cancer of the esophagus
which were treated by either resection or colon by-pass. Interestingly enough 25 cases out of the
total had been previously treated by conservative means, such as either direct esophageal bouginage
or retrograde dilation through a permanent gastrostomy for months or even years until they cause
to definitive reconstruction surgery.
The organs chosen for the replacement were mostly right and left colon and the routes were
intra-thoracic, subcutaneous, and substernal.
In 25 cases from the tital, the anothers used their substernal tunneller in creating the substernal
space safely and bringing up the organs chosen to be anatomosed to the proximal esophagus into
the neck satisfactorily.
The authors feel that the usage of the tunneller has helped them a great deal in lowering the
post-operative complications, such as pneumothorax suppurative mediastinitis, and instantaneous
vascular injuries of the bowel used for replacement. The cases of fistula resulted from the leakage
at the site of anastomosis which were mostly from not properly fucttioning end to side anatomosis,
and not healed up by conservative measures were re-operated and treated by end to end anastomosus
rather than just closing the fistula in the usual fashion. From the experience the authors emphsize
that it would be advisable to perform an end to end esophago-colostomy rather than end to side
anastomosis in case of reconstructing. The esophagus for caustin stricture. This benefits also
not only the surgeon, but also the patients in case the distal portion of the ulcerative, scarry,
esophagus which is not fuction needs to be removed. The authors are rather strongly convinced
that the partial resection of one-third of the clavicle and portion of the strenum together with
paying attention to the length of the colon used for esophageal replacement, must be just right so
as not to stretch the organ and injure the colon vessels, has greatly reduced the incidence of post
operative regurgitation.
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KEYWORD
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