食管及贲门癌手术少见并发症临床分析

Clinical analysis of uncommon complications in esophageal and cardiac cancer operations

目的:总结食管及贲门癌手术少见并发症的诊断及治疗体会,吸取其诊断失误、治疗失败的教训。方法:回顾性分析少见并发症的发病原因、临床诊断、处理方法、预防措施及其中治疗失败的相关因素。结果:治愈及死亡分别为10例及8例(除外已报道的8例)。结论:1)该文所述的并发症虽然少见,但临床上时有发生,若处理不当,常造成严重后果;2)对主动脉食管固有支撕脱性损伤的喷射状出血,术者要沉着、冷静,只要处理方法正确,损伤口均可以修补成功;3)右胸径路是预防奇静脉损伤的关键措施;4)吻合口腹内瘘的患者,若早期漏出感染物包裹于膈下,容易延误诊断;5)吻合口主动脉瘘,关键在于预防;6)警惕术后肺动脉栓塞的发生,提高其防治意识;7)胸胃纵隔疝若不及时处理,预后较差。

Objective： This study aimed to summarize the diagnosis and treatment of uncommon complications in esophageal and cardiac cancer operations as well as obtain lessons from the failure. Methods： The etiology, clinical diagnosis, treatment, prevention measures, and factors that contribute to the failure of the uncommon complications were analyzed retrospectively. Results： Results showed ten cured cases and eight death cases （except for the reported eight cases）. Conclusion： The following conclusions were obtained. 1） The complications described in this paper were rare, but they sometimes occur clinically. If wrong treatment was taken, serious consequences would be expected. 2） Once a jet-like bleeding of aortic esophagus avulsion injury occurs, the surgeon must be calm and take proper treatment to successfully patch up the wounds. 3） The right thoracic approach is a new approach to prevent the injury of azygos vein. 4） Patients with anastomotic stoma fistula easily cause a delay in diagnosis if the leakage was wrapped in the inferior phrenic. 5） Taking preventive measures is the key method for the anastomotic aortoesophageal fistula. 6） Occurrence of pulmonary em- bolism after operation should be monitored. 7） Thoracic gastric mediastinal hernia would cause serious consequences if treatment was not taken at a proper time.