30. 血管吻合を伴う食道再建術と周術期管理

Esophageal Reconstruction with Vascular Anastomosis and Perioperative Management

胃管作成不能な食道切除後症例においては，有茎腸管を用いた再建を必要とする．また頸部食道切除あるいは咽頭・喉頭・頸部食道切除後の食道再建には遊離空腸再建を行う．遊離空腸再建においては血管吻合が必須であり，有茎腸管再建においても血管吻合を要することがある．本稿では血管吻合を伴う食道再建の手術手技と周術期管理について概説する．

Esophageal reconstruction using intestine is often performed for esophageal cancer patients in cases where the stomach cannot be used. We have previously performed reconstruction using ileocolon with supercharge and drainage as our 1st choice in those cases. However, a less invasive, simpler, and safer reconstructive technique using pedicled jejunal flap has recently become popular at our facility.

When making the pedicled jejunal flap, the 1st jejunal vascular arcade was preserved, which in many cases allowed it to be pulled up to the cervical region by processing and transection up to the 2nd jejunal vascular branch. But supercharge and superdrainage may be required for pedicled jejunal flap reconstruction when blood flow of jejunal flap is not good condition. And free jejunal reconstruction is performed to reconstruction after cervical esophagectomy. Vascular anastomosis is essential for free jejunal reconstruction. This article describes the surgical technique and perioperative management of esophageal reconstruction with vascular anastomosis．