胃代食管术后胸胃穿孔的病因及治疗

Etiology and treatment of intra thoracic gastric perforation after esophageal reconstruction with stomach

目的探讨食管切除胃代食管术后近期胸胃穿孔的病因及治疗措施。方法对胸胃穿孔和胸食管胃吻合口瘘各16例的发病原因、临床诊断特点和治疗进行对比分析。结果二次开胸术中见16例为吻合口区外之胃壁局限性坏死穿孔或撕裂,其中8例源于胃受挫压或大块结扎后缺血坏死,5例为缝针穿透胃壁全层,3例为胃大小弯角包埋欠妥。全部采用穿孔区修补或加生机组织覆盖。15例手术成功,术后未再发瘘。结论胸胃穿孔的原因与手术技术操作相关,术后早期发生,宜尽早二次开胸修补,成功率达93·8%。

Objective To investigate the etiological factors and treament of thoraco-gastric perforation （TGP） after esophagngastrostomy. Methods Retrospective analysis was carried out in 16 patients with thoraco-gastric perforation after esophagngastrostorey in our department from March 1974 to March 2004. The etiological factor, clinical feature, experiment test and the method of treatment were compared between TC, P and patients of thoracic esophageal anastomosis leak （TEAL）.Reaults Thoraco-gastric perforation occurs within 2～ 5 days postoperatively. Among these 16 cases, in 8, local necrosis of gastric wall was found which was caused by severe contusion and massive ligature. In 5, were penetrative injury of gastric wall caused by suture needle. In 3, unsuitable pursestring suturing of corner of greater or lisser gastric curvature. Hydropneumothorax occuned after thoraco-gastric perforation. Chest fluid was brown and turbid with putrefactive odor. With medium examination, anastomosis was normal, but medium and air bubbles were found outside of the stomach. Perforation were repaired and covered by pedicle tissue-flap in all cases. 15 cases were cured with no sequence. Conclusion TGP after esophngectomy were correlated with technique of surgery. TGP often occurs early after esophagngastrnstomy. Transthoracic repairing of TGP should be done as soon as possible. The healing ratio of reparation was about 93.8%.