Using Apron and Jejunal Flap Reconstruction for Leakage Management after Gastric Pull Up for Esophageal Cancer-Two Cases Report

使用Apron Flap及Jejunal Flap重建食道切除併胃轉位手術術後吻合處滲漏－兩案例報告

蔡栩云(Hsu-Yun Tsai) ； 謝式洲(Shyh-Jou Shieh)

《臺灣整形外科醫學會雜誌》 28卷4期 (2019/12) Pp. 317-328

摘要

Background: Gastric pull up has become the standard operation in resectable thoracic esophageal cancer. The most common and challenging complication for this type of operation is esophagogastrostomy leakage and necrosis. Aim and Objectives: We aim to share our reconstruction principles in managing this kind of complex complication. Materials and Methods: Two middle aged men received gastric pull up but were both complicated by esophagogastrostomy circumferential necrosis. Both patients were managed with three staged operation including attain viable clean wound bed with apron flap for esophageal diversion, achieve functional continuity with jejunal flap and definite skin coverage with local flap, regional flap or pedicled flap. Conclusion: The postoperative course for both patients was smooth, with both functional and aesthetic outcomes satisfactory.

關鍵字

esophageal cancer ； gastric pull up ； esophagogastrostomy necrosis ； jejunum flap

並列摘要

背景：食道切除併胃轉位手術對於可切除之食道癌病患是標準手術。吻合處滲漏甚至是壞死是此術後很困難處理的併發症。目的及目標：藉由兩個食道切除併胃轉位手術術後吻合處壞死併滲漏的案例，我們分享自己的經驗並整理文獻。材料及方法：兩位中年男性被診斷食道癌後接受食道全切除及胃轉位手術。術後一周內出現吻合處壞死併傷口感染及癒合不良。我們利用吻合處滲漏之重建策略處理此併發症。重建策略包含使用頸部圍裙式皮瓣（apron flap），將食道近端開口轉移至頸部，以得到乾淨傷口，再以空腸顯微移植重建使腸胃道解剖及功能構造連續及利用局部皮瓣、區域皮瓣或帶莖皮瓣達到空腸暴露傷口的覆蓋。結論：兩位病人的術後皆順利恢復。後續追蹤進食及外觀的恢復都滿意且良好。