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右側結腸을 利用한 胸骨下食道成形術

Substernal Esophagoplasty Using Right Colon

최신의학 1959년 2권 5호 p.91 ~ 95
김광연, 洪弼勳,
소속 상세정보
김광연 (  ) - 연세의대외과
洪弼勳 (  ) - 延世醫大 外科

Abstract


Reestablishment of conduit between upper esophagus and louver digestive tract in the correction of esophageal stricture for benign as well as malignant lesions is one of the unsolved problems in esophageal surgery. In the past, various substitutes such as skin tubes, plastic materials, stomach, jejunum have been utilized with varying success. Generally speaking, these substitutes have not been uniformly successful. Fairly recently, a revived interest has been shown in the use of colon segment by various workers with considerable success. This report is based on the clinical experience in 4 cases of esophageal strictures due to lye in whom the right colon was utilized as the passage between the upper esophagus and stomach.
The operative technique in 4 these cases was similar except for minor modifications. In two adults female cases, the right colon was utilized substernally i i an isoperistaltic manner, the blood supply being from the mid-colic artery. The 3rd patient had an identical operation except for the fact that the mesenteric vein was anastomosed to one of the neck veins to promote venous return from the bowel. In the 4th patient, the right colon was anastomosed to the esophagus in an antiperistaltic manner utilizing ileocolic artery because its blood supply apeared excellent. One case died during the immediate post operative period presumably from air-way obstruction. gn one of the other patients colon went into necrosis at the upper portion from compromised blood supply. Two patients had excellent results although they had salivary fistulas for various length of time post-operatively.
The colon seems to have two advantages for this purpose. One is its abundant bleed supply and the other its length which is so essential in the repair of a high esophageal stricture. However, this is a procedure of a considerable magnitude which requires at 4 least suture lines. Therefore, it is essential that the operator should have an open mind in the selection of the substitute. It is our policy now to choose either jejunum. or colon depending on the anatomical advantages found at laparatomy. In this way only, the surgeon may be able to offer the most advantageous method in a given case and hope to get a most satisfying result.

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