Tendințe de evoluție în reconstrucția esofagului

Abstract

Introducere. Există diferite metode de substituție a esofagului rezecat în dependență de caracterul şi localizarea procesului patologic de calea de acces, de înlăturarea segmentară sau extirparea totală a organului, de materialul de substituție folosit şi metoda de ascensionare a grefei. Scopul: Relevarea tendințelor de reconstrucție a esofagului, în clinica de Chirurgie FEC MF. Material şi metode. În fişa noastră de observație (1977-2011) deținem 240 cazuri de intervenții reconstructive pe esofag. În timp ce registru de patologii indicate în rezecții de esofag, material de substituție utilizat şi căile de ascensionare ale transplantului rămân în ansamblu aceleaşi, în structura lor se observă diferite preferințe. Dacă în primele decade de lucru 90% din volumul total de intervenții dețineau operațiile pentru stenozele postcaustice, în ultimul cincinal (2007-2011) 56% din intervenții au constituit procesele neoplazice. Grefa gastrică serveşte drept material de substituție preferabil 40% (în trecut 17%), colonul deținea 48% acum 30%, jejunul rămâne la nivelul precedent - 30%. Cu referire la căile de ascensionare a grefei folosim mai frecvent calea prin mediastinul posterior – 40%, retrosternală – 25%, intrapleurală – 35%. Concluzii. Toate metodele de substituție a esofagului cu consemnarea avantajelor şi dezavantajelor în fiecare caz individual au dreptul la existență. În clinica Chirurgie FEC MF s-a stabilit următoarea tactică de reconstrucție esofagiană: 1) în stenozele postesofagita peptică și esofag Barrett - rezecția esofagului afectat cu substituția lui cu segment jejunal a la Roux prin laparotomie și toracotomia; 2) în cancerul esofagului mediu toracic - extirparea esofagului cu substituția lui cu grefă gastrică din curbura mare prin trei căi de acces – toracotomie, laparotomie, cervicotomie; 3) în stenozele postcaustice extinse și în cancerul treimii superioare a esofagului utilizăm extirparea esofagului cu substituția lui cu colon prin trei căi de acces.

Introduction. There are different methods of substitution of resected esophagus, it depends on the type and localization of pathological process, surgical approach, segmental resection or total extraction of esophagus, depends on the material of substitution used and the method of graft preparation. Purpose. The development of reconstructive surgery of esophagus in the department of surgery, CME Faculty. Materials and methods. In our statement of observation (1977-2011) we have 240 cases of reconstructive interventions in the esophagus. While the indications for esophageal resection, replacement material used and methods of graft preparation remain the same, different preferences can be observed in their structure. If the first decade of work 90% of the total volume of interventions were operations for postcaustic stenosis, in the last five-year 2007-2011, 56% of interventions were the neoplastic processes. Gastric graft is preferable substitute material 40% (in the past 17%), colon had 48% now 30%, jejunum remains at the previous level of 30%. With reference to the way of ascension graft, frequently used path through the posterior mediastinum 40%, retrosternal -25%, intrapleural – 35%. Conclusions. All methods of replacement of the esophagus to record the advantages and disadvantages in each individual case have the right to existence. In the department of surgery CEM was established following tactics of esophageal reconstruction: • In stenosis after peptic esophagitis and Barrett esophagus – resection of esophagus and substitution with jejunal segment Roux by laparotomy and thoracotomy; • In medium thoracic esophageal cancer used esophageal extirpation and its substitution with gastric graft by thoracotomy, laparotomy and cervicotomy; • In extended postcaustic stenosis and cancer of the upper third of esophagus used esophageal extirpation by three pathways.

Introduction. There are different methods of substitution of resected esophagus, it depends on the type and localization of pathological process, surgical approach, segmental resection or total extraction of esophagus, depends on the material of substitution used and the method of graft preparation. Purpose. The development of reconstructive surgery of esophagus in the department of surgery, CME Faculty. Materials and methods. In our statement of observation (1977-2011) we have 240 cases of reconstructive interventions in the esophagus. While the indications for esophageal resection, replacement material used and methods of graft preparation remain the same, different preferences can be observed in their structure. If the first decade of work 90% of the total volume of interventions were operations for postcaustic stenosis, in the last five-year 2007-2011, 56% of interventions were the neoplastic processes. Gastric graft is preferable substitute material 40% (in the past 17%), colon had 48% now 30%, jejunum remains at the previous level of 30%. With reference to the way of ascension graft, frequently used path through the posterior mediastinum 40%, retrosternal -25%, intrapleural – 35%. Conclusions. All methods of replacement of the esophagus to record the advantages and disadvantages in each individual case have the right to existence. In the department of surgery CEM was established following tactics of esophageal reconstruction: • In stenosis after peptic esophagitis and Barrett esophagus – resection of esophagus and substitution with jejunal segment Roux by laparotomy and thoracotomy; • In medium thoracic esophageal cancer used esophageal extirpation and its substitution with gastric graft by thoracotomy, laparotomy and cervicotomy; • In extended postcaustic stenosis and cancer of the upper third of esophagus used esophageal extirpation by three pathways.