Free Jejunum Flap for Secondary Corrosive Injury Reconstruction-A Case Report

以游離空腸皮瓣重建多次腐蝕性食道灼傷－病例報告

何建良(Chien-Liang Ho) ； 謝式洲(Shyh-Jou Shieh) ； 李經維(Jing-Wei Lee) ； 賴吾為(Wu-Wei Lai) ； 邱浩遠(Haw-Yen Chiu)

《中華民國整形外科醫學會雜誌》 14卷3期 (2005/09) Pp. 231-238

https://doi.org/10.7096/JPSA.200509.0231

摘要

化學腐蝕性食道灼傷，常常是由於誤食或刻意自殘而食入腐蝕性的強酸或強鹼物質進而造成食道的傷害，在急性期可因為消化道的穿孔而引發各種併發症甚至死亡，而晚期可能引起食道或幽門的狹窄，壞死甚至發生食道癌的機會，而食道重建對於這類病患來說，更是悠關病人日後的生活品質，對於不只一次的食道灼傷的病患而言，如何實行多次的食道重建對醫師，更是嚴格的考驗。
這位33歲女性，患有憂鬱症，於16歲時因食用強酸自殘，之後利用迴腸－結腸皮瓣來重建食道，而能順利進食。於16年後，又因憂鬱症病發而食用強酸自殘，造成部份迴腸－結腸的嚴重狹窄，本院的胸腔外科與整形外科利用剩餘的迴腸－左側結腸與顯微手術的血管縫合加強血液循環來重建新的食道。在術後第10天發生吻合端洩露及瘻管形成，最後我們利用傳統的游離空腸皮瓣來實行第三次的食道重建，並且得到良好的癒後。

並列摘要

Ingestion of corrosive substances can lead to severe injuries to the gastrointestinal tract and can even result in death. The degree and extent of damage depends on the type of substance, the quantity and the intention. In the acute stage, perforation and necrosis may occur. Long-term complications include stricture formation in the esophagus, antral necrosis, and development of esophageal carcinoma. It is a challenge for surgeons to perform esophageal reconstruction for these patients. Candidates for reconstruction to replace the esophagus include the stomach, jejunum, ileo-colon or colon, and skin flaps. The choices of substitutes were influenced by severity of the injury and the organs involved. When corrosive injury occurs, the stomach is frequently injured. Here we report a case in which the patient received reconstructions of the esophagus more than once due to a second intake of corrosive substances. The patient received an ileo-colon flap interposition for esophageal reconstruction after her first intake of an acidic solution. Her life quality was acceptable afterwards until she suffered from another episode of mental breakdown sixteen years later. The remnant ileo-left colon graft was used combined with microvascular supercharge for the second time reconstruction of the esophagus. Complications such as anastomosis leakage and stricture of neo-neoesophagus were noted, however. Reconstruction with a free jejunum flap was performed after resecting the narrowed part of the neo-neoesophagus. Post-operative outcome was satisfactory and no dysphagia was noted after one year follow-up.

並列關鍵字

corrosive injury ； remnant ileo-colon graft ； free jejunum flap