背景虽然全咽喉食管切除术(TPLE)后的游离空肠转移(FJT)是一种可靠的重建技术,空肠皮瓣被认为比标准游离皮瓣更容易缺血。动物研究表明,空肠可以耐受缺血两到三个小时。临床研究还报道了FJT缺血超过3小时后并发症增加。传统上,我们的机构已经进行了FJT与最初的肠吻合术,然后是血管吻合术,这通常会导致空肠缺血时间延长。在这项研究中,我们回顾性地检查了空肠对缺血的实际耐受性,考虑围手术期并发症和术后吞咽困难。方法回顾性研究402例TPLE+FJT患者。根据空肠缺血时间将患者分为五组(~119min,120~149min,150~179min,180~209min,210分钟~),在组间比较每个变量和结果项。进行了单因素和多因素分析,以确定影响四个结果的独立因素:三个围手术期并发症(椎弓根血栓形成,吻合口漏,手术部位感染(SSI)),术后6个月出现吞咽困难。结果空肠缺血时间平均为164.6±28.4(90~259)min。比较各组空肠缺血时间,我们发现在总体结局或并发症方面无显著差异.我们的多变量分析表明,空肠缺血时间对三种围手术期并发症和术后吞咽困难没有影响。结论在TPLE+FJT中,空肠缺血时间长达4小时对围手术期并发症或术后吞咽困难无影响.TPLE+FJT技术,首先涉及空肠吻合,然后是血管吻合,受益于更容易的空肠吻合,但患有更长的空肠缺血时间。然而,我们发现缺血时间不会带来重大问题,尽管我们尚未评估空肠缺血超过4小时的影响。
BACKGROUND: While free
jejunum transfer (FJT) following total pharyngo-laryngo-esophagectomy (TPLE) is a reliable reconstruction technique, the
jejunum flap is viewed as more susceptible to ischemia than a standard free flap. Animal studies have indicated that the
jejunum can tolerate ischemia for as little as 2 to 3 hours. Clinical studies also reported increased complications after the FJT with more than 3 hours of ischemia. Traditionally, our institution has carried out FJT with an initial intestinal anastomosis, followed by a vascular anastomosis, which often results in extended jejunal ischemia time. In this
study, we retrospectively examined the actual tolerance of the
jejunum to ischemia, considering perioperative complications and postoperative dysphagia.
METHODS: We retrospectively studied 402 consecutive cases involving TPLE + FJT. Patients were divided into five groups based on
jejunum ischemia time (∼119 minutes, 120∼149 minutes, 150∼179 minutes, 180∼209 minutes, 210 minutes∼), with each variable and result item compared between the groups. Univariate and multivariate analyses were conducted to identify independent factors influencing the four results: three perioperative complications (pedicle thrombosis, anastomotic leak, surgical site infection) and dysphagia at 6 months postoperatively.
RESULTS: The mean jejunal ischemia time was 164.6 ± 28.4 (90-259) minutes. When comparing groups divided by jejunal ischemia time, we found no significant differences in overall outcomes or complications. Our multivariate analyses indicated that jejunal ischemia time did not impact the three perioperative complications and postoperative dysphagia.
CONCLUSIONS: In TPLE + FJT, a jejunal ischemia time of up to 4 hours had no effect on perioperative complications or postoperative dysphagia. The TPLE + FJT technique, involving a jejunal anastomosis first followed by vascular anastomosis, benefits from an easier jejunal anastomosis but suffers from a longer jejunal ischemia time. However, we found that ischemia time does not pose significant problems, although we have not evaluated the effects of jejunal ischemia extending beyond 4 hours.