気管食道再建術 頚部食道癌に対する咽頭喉頭食道全摘後の胃による再建

Abstract

In patients with cervical esophageal cancer, when the tumor is located in the neck, reconstructive surgery can be performed in the neck using a jejunal free graft. But in cases where the tumor extends down to the thoracic esophagus, total pharyngolaryngoesophagectomy is often made and reconstruction is most commonly performed with the stomach. However, sometimes the stomach is too short to be anastomosed to the pharynx. In this condition, we use a reconstructive method using a stomach and jejunum composite. The stomach pedicled only on the right gastroepiploic vessels can be easily stretched to the pharynx using a division just distal to the pyloric ring. Thus, for the purpose of the gastrojejunostomy, the pyloric part is partially resected. The duodenal stump is closed and end-to-side gastrojejunostomy is performed with a Roux-en-Y loop which is placed about 40cm distal to the gastrojejunostomy.Postoperative examination has revealed good passage and no reflux of bile.