食管癌切除术后急性气管水肿的防治

Prevention and treatment of acute trachea edema after esophagectomy

目的总结外科手术治疗食管癌并发急性气管水肿的临床经验。方法回顾性分析我院收治的2342例胸上、中、下段食管癌患者的临床资料,其中剖左胸行食管癌切除,经食管床颈部食管胃吻合术1920例,主动脉弓上吻合183例,主动脉弓下吻合142例,剖右胸-上腹-颈三切口胃代食管吻合术97例。结果术后并发急性气管严重水肿7例(0.3%),均为女性患者,均行气管切开术后治愈。结论食管癌切除术后急性气管水肿是一严重并发症,气管前闻及高调、粗糙、酷似锯木样的气管呼吸音是气管水肿的主要诊断依据之一;对严重呼吸困难者应立即行气管切开术,保证呼吸道通畅;术中手术操作细致以及与麻醉医师密切配合,对预防食管癌术后并发急性气管水肿有积极的作用。

Objective To summarize the Methods The clinical data of 2342 experiences in treating acute trachea edema after esophagectomy. patients with esophageal cancer located in upper thoracic, midthoracic or lower thoracic esophagus, who underwent esophagectomy in our hospital, were analyzed retrospectively. There were 1920 patients underwent esophagetomy using a left thoracic incision, with the esophagogastric anastomosis performed in a cervical incision, while 183 patients with anastomosises performed superior to the aortic arch in the left chest, and 142 inferior to the aortic arch. Another 97 patients received an esophagetomy using right thoracic, contiguous abdominal and cervical incisions with the anastomosis performed in the cervical incision. Results Seven out of 2342 patients developed acute trachea edema after surgery. All these 7 patients were female and eventually trachea edema is a severe complication of esophagectomy and cured by tracheotomy. Conclusion Acute should be carefully managed .