Surgical treatment of traumatic intrathoracic esophageal perforations by foreign bone / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the staging criteria and surgical treatment strategy of traumatic intrathoracic esophageal perforations by foreign bone.</p><p><b>METHODS</b>Fifty-seven patients with intrathoracic esophageal perforations caused by foreign bone in our department from January 1980 to June 2006 were studied. Patients were divided into 4 grades: grade I was esophageal perforation without mediastinitis (n=17), grade II was esophageal perforation with severe mediastinitis (n=13), grade III was esophageal perforation with severe empyema (n=21), grade IV was esophageal perforation with tracheal or aorto-esophageal fistula (n=6). Based on the stage of esophageal perforation, operative procedures were selected including esophagotomy, esophageal repair, esophagectomy, mediastinal drainage, and esophagus reconstruction with colon.</p><p><b>RESULTS</b>In grade I, II and III, all but one patient experienced satisfactory healing of the esophagus. One patient died of multi-organ failure from septic complication. No leakage was observed. Normal swallowing function and improved weight gain was achieved in all the patients. There were 2 deaths in grade IV (2/6).</p><p><b>CONCLUSIONS</b>Grading of esophageal perforation caused by foreign bone is helpful to the decision of surgical treatment strategy.</p>

Observation on the long-term complications after esophageal replacement with colon / 中华外科杂志

<p><b>OBJECTIVE</b>To study the etiology and preventive measures of the long-term postoperative complication after esophageal replacement with colon for esophageal benign disease.</p><p><b>METHODS</b>To review the clinical data of 577 patients with esophageal replacement with colon our department, including 123 cases of esophageal benign disease. Of all, there were 25 cases-time for 11 cases following with severe complication: redundancy and dilated colon 12 cases-time, severe stricture of stoma 4, macrocyst esophagus 2, colon-stomach stoma expansion 4, mechanical obstruction of colon 3. The etiology included iatrogenic and functionality. The therapy included stricture form or resection, redundancy segment resection, obstructed segment solution and stoma resection and form.</p><p><b>RESULTS</b>Eight cases underwent once operation, 2 case twice, 1 case three times. After operation, 9 cases took food normally, 2 improved symptoms obviously.</p><p><b>CONCLUSIONS</b>The iatrogenic and functionality factor contributed to severe complication after esophageal replacement with colon for esophageal benign disease. The preventive measure is followed during operation: cervical esophageal-colon anastomosis exceed 2.5 centimeter, abdominal colon-stomach anastomosis reflux, channel width of colon passage, intestinal canal lay up straight. Re-operation is best choice to for local stricture, colon expansion, redundancy and dilated colon.</p>

Classification and surgical treatment of intrathoracic esophageal injury caused by foreign body / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the classification criterion and surgical treatment strategy of intrathoracic esophageal injury caused by foreign body.</p><p><b>METHODS</b>Eighty-four patients with intrathoracic esophageal injury caused by foreign body in our department from January 1980 to April 2004 were divided into 4 grade: grade I was non-penetrated injury of esophagus (18 cases); grade II was esophageal perforation with mild mediastinitis (39 cases); grade III was esophageal perforation with severe intrathoracic infection (17 cases); grade IV was aortoesophageal fistula (10 cases). Based on the degree of esophageal injury and the extension of inflammation, operative procedures were selected including esophagotomy, esophageal reparation, esophagectomy, mediastinal drainage, reparation of fistula and replacement of aorta.</p><p><b>RESULTS</b>Patients in grade I and II were all cured . One death occurred in grade III (1/17), the same in Grade IV was 9 (9/10).</p><p><b>CONCLUSIONS</b>Classification of esophageal injury caused by foreign body is helpful to the decision of surgical treatment strategy. The prevention of aortoesophageal fistula is the key point of reducing of mortality.</p>

Surgery for upper or middle thoracic esophageal carcinoma after gastrectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical treatment and technical key-points of upper or middle thoracic esophageal carcinoma in patients with history of gastrectomy.</p><p><b>METHODS</b>Eighty-six patients with upper or middle thoracic esophageal carcinoma after previous gastrectomy received surgical treatment between 1980 and 2004. Among them, tumor location was in middle thoracic esophagus in 50 patients, in upper thoracic esophagus in 31 and cervical esophagus in 5. Postoperative pathological staging was stage I in 16 patients, stage IIa in 62, stage IIb in 5 and stage III in 8. The interval between gastrectomy and the diagnosis of esophageal carcinoma ranged from 2 to 22 years. Surgical procedures included esophagectomy and reconstruction with nonreversed gastric tube in 2 patients and reversed gastric tube in 3. The esophagus was reconstructed with short segment of colon in 5 patients and long segment of colon in 74. Two cases underwent jejunostomy only.</p><p><b>RESULTS</b>Seventy-six patients (88%) were treated with curative intent. Seven patients (8%) received palliative surgery. Postoperative complication rate was 12% (10/86). One patient died of multiple organ dysfunction syndrome (MODS). Sixty-seven patients were followed up, the 1-, 3-, 5-year survival rates were 84% (56/67), 57% (38/67) and 22% (15/67), respectively.</p><p><b>CONCLUSIONS</b>Surgical treatment is the first choice for esophageal cancer patients after gastrectomy although the procedures are complicated. The surgery should be considered as a reliable therapeutic modality because of favorable patient prognosis. The replacement with colon is recommended for those patients.</p>