Development of Esophageal Cancer from a Short Residual Esophagus 20 Years Following Corrosive Injury-Case Report and Treatment

食道灼傷20年後從短的食道殘端發展出食道癌－病例報告及治療

蔡穎瀚(Ying-Han Tsai) ； 姚勝發(Sheng-Fa Yao) ； 劉奕添(Yi-Tein Liu) ； 陳宏基(Hung-Chi Chen)

《中華民國整形外科醫學會雜誌》 18卷3期 (2009/09) Pp. 272-277

https://doi.org/10.7096/JPSA.200909.0272

摘要

背景：
目前已知食道灼傷的病人有機會產生食道癌。在所有的食道癌病人當中，約有1~4%的病人有食道灼傷的病史。1~3幾乎所有文獻上報告的病例都是發生在誤食鹼液之後，而且一開始都沒有接受手術治療。
目標及目的：
一個54歲的男性病人在20年前遭受食道灼傷，他接受了近全食道切除及大腸轉位修補。在20年後發現了食道狹窄，而且從很小的殘留食道端做切片發現食道癌。接著動手術將殘留的食道全部移除，合併橈側前臂自由皮瓣移植重建。然而8個月後做內視鏡檢查發現癌症復發。在腫瘤切除後，我們完成了一個困難的長食道重建。
材料及方式：
這位病人在下頸部發現癌症復發，位置剛好就在表皮皮瓣及轉位大腸的交界處。這次手術將全部的食道包含橈側前臂皮瓣及轉位的大腸全部切除，留下了一個從咽部－直到腹部約40公分長的食道缺損。我們利用管狀的前外側大腿皮瓣及闊筋膜張肌皮瓣來完成這困難的重建，連接咽部到腹部的食道缺損。
結果：
病人恢復良好，而且在術後可順利進食。術後三個月時，食道攝影表現出平順的進食而無滲漏。
結論：
先前有食道灼傷的病人若有任何症狀變化，我們都應該要懷疑可能有灼傷性的食道癌。早期的手術介入治療有病變的食道，可以降低惡性變化的機率。由於重建的技術進步，廣泛性的切除仍然可以執行。

並列摘要

Background:
The chance of developing carcinoma after corrosive injury is well known. Of all the patients with esophageal carcinoma, 1-4% patients have a history of caustic ingestion. 1~3 Nearly all the reported cases in the literature occurred after ingestion of lye, but did not undergo surgical treatment in the beginning.
Aim and Objectives:
A 54-year-old male patient suffered from corrosive injury 20 years ago. He received operation at that time with colon interposition following nearly total esophagectomy. A stricture was found 20 years later, and biopsy from the small residual esophageal segment showed esophageal carcinoma. The residual esophagus was removed and the defect was reconstructed with free radial forearm flap. However, recurrence was found 8 months later during endoscopic examination. A difficult reconstruction for the long esophageal defect was done after tumor resection.
Materials and Methods:
The patient suffered from tumor recurrence in the lower neck just at the junction between the skin flap and interposition colon. This time, complete esophagectomy including the interposition colon segment and forearm flap was successful. A long esophageal defect of about 40cm from pharynx to abdomen was presented. A difficult reconstruction with tubal anterolateral thigh and tensor fascia lata fasciocutaneous free flap was done to connect the pharyx to the abdomen.
Results:
The patient recovered well and was able to digest well post-operatively. Esophagogram showed smooth intake without leakage 3 months later.
Conclusion:
We conclude that corrosive esophageal carcinoma should be suspected in patients with previous corrosive injury if there is any change in their symptoms. Early surgical intervention with the diseased esophagus can lower the rate of malignancy formation. With the improvement of the reconstruction methods, extensive resection still can be done.

並列關鍵字

corrosive injury ； esophageal cancer ； esophageal reconstruction