vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2019-16-3-307-316vestim-508Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEЭзофагоколопластика с планированием при хирургическом лечении карцином пищевода и пищеводно-желудочного переходаColonic esophagoplasty with planning in esophageal and gastroesophageal junction carcinomas surgical treatmenthttps://orcid.org/0000-0002-5314-7618ИльинИ. А.IlyinI. A.

Ильин Илья Анатольевич – канд. мед. наук, вед. науч. сотрудник

223040, агр. Лесной, Минский р-н

Ilya А. Ilyin – Ph. D. (Med.), Leading researcher

ileus@tut.byРеспубликанский научно-практический центр онкологии и медицинской радиологии им. Н. Н. АлександроваN. N. Alexandrov National Cancer Centre201916092019163307316Copyright © Ильин И.А., 20192019Ильин И.А.Ilyin I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/508

Оценена эффективность метода планирования толстокишечной пластики пищевода при хирургическом лечении карцином пищевода и пищеводно-желудочного перехода.

Эзофагоколопластика при нетрансплантабельном желудке выполнена 109 пациентам, из них 72 (66,1 %), страдающим карциномами пищевода, и 37 (33,9 %) с пищеводно-желудочным переходом. При этом у 40,4 % (44/109) пациентов был применен метод планирования (селективная ангиография и пробное пережатие сосудов). Эффективность метода оценивали путем определения влияния на относительные риски смерти от респираторных осложнений (аспирационные пневмонии и респираторный дистресс-синдром взрослых) и от других причин.

Общая частота послеоперационных осложнений составила 66,8 % (73/109). Некроз трансплантата был диагностирован у 7,3 % (8/109) пациентов, несостоятельность пищеводного анастомоза без некроза – у 5,5 % (6/109), пневмония – у 14,7 % (16/109), легочно-сердечная недостаточность – у 5,5 % (6/109), тромбоэмболия легочной артерии – у 0,9 % (1/109). Использование метода планирования позволило снизить риск смерти от респираторных осложнений и от других причин (OP 0,46 [95 % ДИ 0,24–0,89], pCox = 0,021 и OP 0,52 [95 % ДИ 0,29–0,95], pCox = 0,034 соответственно).

Метод планирования эзофагоколопластики позволяет выбрать наиболее подходящий толстокишечный сегмент, заранее спланировать уровни пересечения питающих сосудов и сформировать трансплантат путем субтотальной мобилизации толстой кишки. Неблагоприятными факторами в отношении риска смерти от респираторных осложнений и от других причин являются факт развития некроза трансплантата, наличие длительно существующего шейного свища в условиях раневой инфекции, наличие рефлюкса желчи, III и IV стадии злокачественной опухоли.

The effectiveness of the colonic esophagoplasty planning method for surgical treatment of esophageal and gastroesophageal junction carcinomas is evaluated by analyzing factors that affect the mortality risk from respiratory complications and other causes.

Colonic esophagoplasty in cases of non-transplanted stomach was performed in 109 patients with esophageal carcinomas – 66.1 % (72/109) and gastroesophageal junction carcinomas – 33.9 % (37/109). Esophagoplasty was performed using the planning method (selective angiography and trial clamping of vessels) which was applied in 40.4 % (44/109) patients. The method effectiveness was evaluated by determining the effect of mortality risks (hazard ratio – HR) from respiratory complications (aspiration pneumonia and adult respiratory distress syndrome) and other causes.

Postoperative morbidity was determined in 66.8 % (73/109) observations. Graft necrosis was diagnosed in 7.3 % patients (8/109), esophageal anastomosis leakage without graft necrosis – in 5.5 % patients (6/109), pneumonia – 14.7 % patients (16/109) patients, pulmonary and heart failure – in 5.5 % patients (6/109), pulmonary artery thromboembolism – in 0.9 % patients (1/109). The use of the planning method reduced the mortality risk from respiratory complications and from other causes (HR 0.46 [95 % CI 0.24–0.89], pCox = 0.021 and HR 0.52 [95 % CI 0.29–0.95], pCox = 0.034, respectively).

The planning method allows selecting the most suitable colonic segment, planning in advance the levels of feeding vessels intersection and forming a graft by subtotal colon mobilization. Adverse factors in relation to the mortality risk from respiratory complications and from other causes are the fact of graft necrosis development, the presence of long-existing cervical fistula in conditions of wound infection and the presence of bile reflux, stage III and IV of malignant tumors.

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The authors declare that there are no conflicts of interest present.