Clinical analysis of 37 unplanned re-operations of esophageal and cardiac carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

陸超敬 , 陳和忠 ,  楊立信

第二軍醫大學長海醫院胸外科（上海 200433）;

Corresponding?author：

楊立信, Email: yanglxxx2011@126.com

Keywords：

食管癌; 二次手術; 術后并發癥

DOI：

10.7507/1007-4848.201608078

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目的探討食管賁門癌術后非計劃二次手術的原因及有效的預防和治療措施。方法回顧性分析 2010 年 1 月至 2016 年 1 月在我院胸外科實施食管賁門癌手術 2 655 例患者的臨床資料，37 例（1.4%）患者因嚴重并發癥實施了非計劃二次手術，其中男 28 例、女 9 例，年齡 65（48～79）歲，總結該 37 例患者的臨床特征、二次手術的原因及治療方法。結果吻合口瘺 11 例：1 例行空腸造瘺，2 例行胸壁切口清創+胸腔置管引流術，3 例行頸部切口清創+上縱隔置管引流術，5 例行胸腔探查術（其中 3 例行瘺口修補術），1 例胸胃瘺行胸胃部分切除+食管頸部曠置+空腸造瘺術。乳糜胸 13 例，經胸行胸導管結扎術，其中 1 例右胸結扎失敗后再次經腹腔縫扎胸導管。胸腔出血 6 例行開胸探查止血，腹腔出血 2 例，分別經左胸及腹正中探查止血。1 例胸胃扭轉，行吻合口切除+胃-食管端端再次吻合術。1 例因雙側聲帶麻痹行氣管切開；1 例因肺大皰破裂氣胸行胸腔鏡下肺大皰切除術；1 例因腸梗阻行開腹探查粘連松解+空腸造瘺術。1 例胸內瘺患者因二次術后肺部感染死亡，其余患者均治愈出院。結論食管賁門癌術后二次手術的主要原因為吻合口瘺、乳糜胸及出血，提高首次手術質量是預防二次手術發生的關鍵，對需要行二次手術治療的嚴重并發癥，及時果斷的決定可避免病情進一步惡化和提高二次手術的效果。

Citation： 陸超敬, 陳和忠, 楊立信. Clinical analysis of 37 unplanned re-operations of esophageal and cardiac carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(12): 998-1001. doi: 10.7507/1007-4848.201608078 Copy

1.	王冠英, 王宏斌, 鄭新瑞, 等. 非計劃二次手術監控的實踐與思考. 中國醫院, 2013, 17(8): 26-27.
2.	王志強, 謝宗濤, 蔡銘, 等. 36 例食管賁門癌術后二次手術臨床分析. 現代腫瘤醫學, 2009, 17(2): 268-269.
3.	楊永波, 閆萬璞, 熊宏超, 等. 食管癌二次手術 19 例原因分析. 中華胃腸外科雜志, 2014, 17(5): 492-494.
4.	Sarela AI, Tolan DJ, Harris K, et al. Anastomotic leakage after esophagectomy for cancer: a mortality-free experience. J Am Coll Surg, 2008, 206(3): 516-523.
5.	Li B, Xiang J, Zhang Y, et al. Factors affecting hospital mortality in patients with esophagogastric anastomotic leak: a retrospective study. World J Surg, 2016, 40(5): 1152-1157.
6.	黃偉釗, 吳穎猛, 葉紅雨, 等. 食管癌術后消化道瘺的個體化治療. 中國胸心血管外科臨床雜志, 2011, 18(5): 469-471.
7.	Turkyilmaz A, Eroglu A, Aydin Y, et al. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus, 2008, 22(2): 119-126.
8.	Guo J, Chu X, Liu Y, et al. Choice of therapeutic strategies in intrathoracic anastomotic leak following esophagectomy. World J Surg Oncol, 2014, 12(1): 1-7.
9.	徐凱, 謝宏亞, 馬海濤, 等. 胸腔內食管-胃吻合口瘺診治新模式初步研究結果.中華外科雜志, 2016, 54(2): 114-118.
10.	林海平, 李萍, 池嘉昌, 等. 食管癌術后胸內吻合口瘺的精確引流. 中國胸心血管外科臨床雜志, 2016, 23(6): 577-580.
11.	Low DE. Diagnosis and management of anastomotic leaks after esophagectomy. J Gastrointest Surg, 2011, 15(8): 1319-1322.
12.	孫志勇, 富皓白, 曹子昂, 等.帶膜食管支架置入治療食管癌術后胸內食管吻合口瘺. 中國胸心血管外科臨床雜志, 2012, 19(3): 334-335.
13.	Dasari BV, Neely D, Kennedy A, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg, 2014, 259(5): 852-860.
14.	Persson S, Rouvelas I, Kumagai K, et al. Treatment of esophageal anastomotic leakage with self-expanding metal stents: analysis of risk factors for treatment failure. Endosc Int Open, 2016, 4(4): E420-E426.
15.	楊光煜, 何苡, 胡為才, 等. 53 例食管癌賁門癌術后吻合口瘺及相關并發癥的處理. 中華胸心血管外科雜志, 2014, 30(1): 11-13.
16.	劉海峰, 王獻增, 付金書, 等. 胸內食管胃吻合口瘺再手術治療的臨床分析.中國胸心血管外科臨床雜志, 2014, 21(6): 836-838.
17.	李敏杰, 段紅兵, 傅成國, 等. 食管癌術后 27 例胸胃瘺臨床分析. 中華胸心血管外科雜志, 2013, 29(3): 136-137.
18.	吳曉峰, 毛志福, 吳江波, 等. 食管癌切除胃代食管術后胸胃瘺發生的預防和手術治療. 海南醫學, 2012, 23(1): 59-60.
19.	Miao L, Zhang Y, Hu H, et al. Incidence and management of chylothorax after esophagectomy. Thorac Cancer, 2015, 6(3): 354-358.
20.	Shah RD, Luketich JD, Schuchert MJ, et al. Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg, 2012, 93(3): 897-903.
21.	耿國軍, 于修義, 郭崴, 等. 術前口服橄欖油預防腔鏡食管癌切除術后乳糜胸的療效分析. 中國胸心血管外科臨床雜志, 2016, 23(7): 710-713.
22.	立偉, 何明, 陳龍奇, 等. 食管癌術中胸導管預防結扎連續 1031 例無乳糜胸手術經驗. 中國腫瘤臨床, 2006, 33(11): 636-637.
23.	Brinkmann S, Schroeder W, Junggeburth K, et al. Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus. J Thorac Cardiovasc Surg, 2016, 151(5): 1398-1404.
24.	D’Amico TA. " Early” thoracic duct ligation for chylothorax after esophagectomy means " now”. J Thorac Cardiovasc Surg, 2016, 151(5): 1405-1406.
25.	Merigliano S, Molena D, Ruol A, et al. Chylothorax complicating esophagectomy for cancer: a plea for early thoracic duct ligation. J Thorac Cardiovasc Surg, 2000, 119(3): 453-457.
26.	Kranzfelder M, Gertler R, Hapfelmeier A, et al. Chylothorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis. Surg Endosc, 2013, 27(10): 3530-3538.
27.	熊輝, 張學華, 晏大學. 食管癌術后乳糜胸的治療. 中國胸心血管外科臨床雜志, 2013, 20(1): 121-122.
28.	Hayden JD, Sue-Ling HM, Sarela AI, et al. Minimally invasive management of chylous fistula after esophagectomy. Dis Esophagus, 2007, 20(3): 251-255.
29.	Mishra PK, Saluja SS, Ramaswamy D, et al. Thoracic duct injury following esophagectomy in carcinoma of the esophagus: ligation by the abdominal approach. World J Surg, 2013, 37(1): 141-146.

1. 王冠英, 王宏斌, 鄭新瑞, 等. 非計劃二次手術監控的實踐與思考. 中國醫院, 2013, 17(8): 26-27.
2. 王志強, 謝宗濤, 蔡銘, 等. 36 例食管賁門癌術后二次手術臨床分析. 現代腫瘤醫學, 2009, 17(2): 268-269.
3. 楊永波, 閆萬璞, 熊宏超, 等. 食管癌二次手術 19 例原因分析. 中華胃腸外科雜志, 2014, 17(5): 492-494.
4. Sarela AI, Tolan DJ, Harris K, et al. Anastomotic leakage after esophagectomy for cancer: a mortality-free experience. J Am Coll Surg, 2008, 206(3): 516-523.
5. Li B, Xiang J, Zhang Y, et al. Factors affecting hospital mortality in patients with esophagogastric anastomotic leak: a retrospective study. World J Surg, 2016, 40(5): 1152-1157.
6. 黃偉釗, 吳穎猛, 葉紅雨, 等. 食管癌術后消化道瘺的個體化治療. 中國胸心血管外科臨床雜志, 2011, 18(5): 469-471.
7. Turkyilmaz A, Eroglu A, Aydin Y, et al. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus, 2008, 22(2): 119-126.
8. Guo J, Chu X, Liu Y, et al. Choice of therapeutic strategies in intrathoracic anastomotic leak following esophagectomy. World J Surg Oncol, 2014, 12(1): 1-7.
9. 徐凱, 謝宏亞, 馬海濤, 等. 胸腔內食管-胃吻合口瘺診治新模式初步研究結果.中華外科雜志, 2016, 54(2): 114-118.
10. 林海平, 李萍, 池嘉昌, 等. 食管癌術后胸內吻合口瘺的精確引流. 中國胸心血管外科臨床雜志, 2016, 23(6): 577-580.
11. Low DE. Diagnosis and management of anastomotic leaks after esophagectomy. J Gastrointest Surg, 2011, 15(8): 1319-1322.
12. 孫志勇, 富皓白, 曹子昂, 等.帶膜食管支架置入治療食管癌術后胸內食管吻合口瘺. 中國胸心血管外科臨床雜志, 2012, 19(3): 334-335.
13. Dasari BV, Neely D, Kennedy A, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg, 2014, 259(5): 852-860.
14. Persson S, Rouvelas I, Kumagai K, et al. Treatment of esophageal anastomotic leakage with self-expanding metal stents: analysis of risk factors for treatment failure. Endosc Int Open, 2016, 4(4): E420-E426.
15. 楊光煜, 何苡, 胡為才, 等. 53 例食管癌賁門癌術后吻合口瘺及相關并發癥的處理. 中華胸心血管外科雜志, 2014, 30(1): 11-13.
16. 劉海峰, 王獻增, 付金書, 等. 胸內食管胃吻合口瘺再手術治療的臨床分析.中國胸心血管外科臨床雜志, 2014, 21(6): 836-838.
17. 李敏杰, 段紅兵, 傅成國, 等. 食管癌術后 27 例胸胃瘺臨床分析. 中華胸心血管外科雜志, 2013, 29(3): 136-137.
18. 吳曉峰, 毛志福, 吳江波, 等. 食管癌切除胃代食管術后胸胃瘺發生的預防和手術治療. 海南醫學, 2012, 23(1): 59-60.
19. Miao L, Zhang Y, Hu H, et al. Incidence and management of chylothorax after esophagectomy. Thorac Cancer, 2015, 6(3): 354-358.
20. Shah RD, Luketich JD, Schuchert MJ, et al. Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg, 2012, 93(3): 897-903.
21. 耿國軍, 于修義, 郭崴, 等. 術前口服橄欖油預防腔鏡食管癌切除術后乳糜胸的療效分析. 中國胸心血管外科臨床雜志, 2016, 23(7): 710-713.
22. 立偉, 何明, 陳龍奇, 等. 食管癌術中胸導管預防結扎連續 1031 例無乳糜胸手術經驗. 中國腫瘤臨床, 2006, 33(11): 636-637.
23. Brinkmann S, Schroeder W, Junggeburth K, et al. Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus. J Thorac Cardiovasc Surg, 2016, 151(5): 1398-1404.
24. D’Amico TA. " Early” thoracic duct ligation for chylothorax after esophagectomy means " now”. J Thorac Cardiovasc Surg, 2016, 151(5): 1405-1406.
25. Merigliano S, Molena D, Ruol A, et al. Chylothorax complicating esophagectomy for cancer: a plea for early thoracic duct ligation. J Thorac Cardiovasc Surg, 2000, 119(3): 453-457.
26. Kranzfelder M, Gertler R, Hapfelmeier A, et al. Chylothorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis. Surg Endosc, 2013, 27(10): 3530-3538.
27. 熊輝, 張學華, 晏大學. 食管癌術后乳糜胸的治療. 中國胸心血管外科臨床雜志, 2013, 20(1): 121-122.
28. Hayden JD, Sue-Ling HM, Sarela AI, et al. Minimally invasive management of chylous fistula after esophagectomy. Dis Esophagus, 2007, 20(3): 251-255.
29. Mishra PK, Saluja SS, Ramaswamy D, et al. Thoracic duct injury following esophagectomy in carcinoma of the esophagus: ligation by the abdominal approach. World J Surg, 2013, 37(1): 141-146.

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