抄録
An esophageal reconstruction using a free bowel graft following pharyngolaryngoesophagectomy for a carcinoma involving the pharynx or cervical esophagus can be termed“typical”free gut transfer, while other types of reconstruction using a free bowel graft can be termed“atypical. ”During the period from 1988 to 1989, we have experienced 23 cases of free gut transfer in our hospital. Twelve cases of these underwent typical operation. An atypical operation was performed in 11 cases involving 4 cases of a carcinoma of the hypopharynx or cervical esophagus, 3 cases of a recurrence following esophagectomy for a carcinoma in the thoracic esophagus, one case of a carcinoma in the esophagus at the cervicothoracic junction, one case with cervical esophagostomy following esophagectomy for a carcinoma in the thoracic esophagus, one case of recurrence following chemotherapy for a breast carcinoma, and one case of pharyngoesophageal corrosive stricture. From our experience of atypical free gut transfer, we conclude that the free gut transfer is useful for the reconstruction of various types of a pharyngoesophageal defect. Also we conclude that the cervical transverse artery and the external jugular vein as the recipient vessels in the neck are most convenient, and the thoracoacromial artery and the cephalic vein are most convenient in the anterior chest wall. Important postoperative complications involved aspiration pneumonia in cases preserving the larynx, dysphagia in cases with free graft of the long intestine, and graft failure due to a vascular obstruction. However, these complications could be avoided with improvement in the operative indications, the procedures and techniques employed.
