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

Authors：

陆超敬 , 陈和忠 ,  杨立信

第二军医大学长海医院胸外科（上海 200433）;

Corresponding author：

杨立信, Email: yanglxxx2011@126.com

Keywords：

食管癌; 二次手术; 术后并发症

DOI：

10.7507/1007-4848.201608078

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目的探讨食管贲门癌术后非计划二次手术的原因及有效的预防和治疗措施。方法回顾性分析 2010 年 1 月至 2016 年 1 月在我院胸外科实施食管贲门癌手术 2 655 例患者的临床资料，37 例（1.4%）患者因严重并发症实施了非计划二次手术，其中男 28 例、女 9 例，年龄 65（48～79）岁，总结该 37 例患者的临床特征、二次手术的原因及治疗方法。结果吻合口瘘 11 例：1 例行空肠造瘘，2 例行胸壁切口清创+胸腔置管引流术，3 例行颈部切口清创+上纵隔置管引流术，5 例行胸腔探查术（其中 3 例行瘘口修补术），1 例胸胃瘘行胸胃部分切除+食管颈部旷置+空肠造瘘术。乳糜胸 13 例，经胸行胸导管结扎术，其中 1 例右胸结扎失败后再次经腹腔缝扎胸导管。胸腔出血 6 例行开胸探查止血，腹腔出血 2 例，分别经左胸及腹正中探查止血。1 例胸胃扭转，行吻合口切除+胃-食管端端再次吻合术。1 例因双侧声带麻痹行气管切开；1 例因肺大疱破裂气胸行胸腔镜下肺大疱切除术；1 例因肠梗阻行开腹探查粘连松解+空肠造瘘术。1 例胸内瘘患者因二次术后肺部感染死亡，其余患者均治愈出院。结论食管贲门癌术后二次手术的主要原因为吻合口瘘、乳糜胸及出血，提高首次手术质量是预防二次手术发生的关键，对需要行二次手术治疗的严重并发症，及时果断的决定可避免病情进一步恶化和提高二次手术的效果。

Citation： 陆超敬, 陈和忠, 杨立信. 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, 郑新瑞, 等. 非计划二次手术监控的实践与思考. 中国医院, 2013, 17(8): 26-27.
2.	王志强, 谢宗涛, 蔡铭, 等. 36 例食管贲门癌术后二次手术临床分析. 现代肿瘤医学, 2009, 17(2): 268-269.
3.	杨永波, 闫万璞, 熊宏超, 等. 食管癌二次手术 19 例原因分析. 中华胃肠外科杂志, 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.	黄伟钊, 吴颖猛, 叶红雨, 等. 食管癌术后消化道瘘的个体化治疗. 中国胸心血管外科临床杂志, 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.	徐凯, 谢宏亚, 马海涛, 等. 胸腔内食管-胃吻合口瘘诊治新模式初步研究结果.中华外科杂志, 2016, 54(2): 114-118.
10.	林海平, 李萍, 池嘉昌, 等. 食管癌术后胸内吻合口瘘的精确引流. 中国胸心血管外科临床杂志, 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.	孙志勇, 富皓白, 曹子昂, 等.带膜食管支架置入治疗食管癌术后胸内食管吻合口瘘. 中国胸心血管外科临床杂志, 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.	杨光煜, 何苡, 胡为才, 等. 53 例食管癌贲门癌术后吻合口瘘及相关并发症的处理. 中华胸心血管外科杂志, 2014, 30(1): 11-13.
16.	刘海峰, 王献增, 付金书, 等. 胸内食管胃吻合口瘘再手术治疗的临床分析.中国胸心血管外科临床杂志, 2014, 21(6): 836-838.
17.	李敏杰, 段红兵, 傅成国, 等. 食管癌术后 27 例胸胃瘘临床分析. 中华胸心血管外科杂志, 2013, 29(3): 136-137.
18.	吴晓峰, 毛志福, 吴江波, 等. 食管癌切除胃代食管术后胸胃瘘发生的预防和手术治疗. 海南医学, 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.	耿国军, 于修义, 郭崴, 等. 术前口服橄榄油预防腔镜食管癌切除术后乳糜胸的疗效分析. 中国胸心血管外科临床杂志, 2016, 23(7): 710-713.
22.	立伟, 何明, 陈龙奇, 等. 食管癌术中胸导管预防结扎连续 1031 例无乳糜胸手术经验. 中国肿瘤临床, 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.	熊辉, 张学华, 晏大学. 食管癌术后乳糜胸的治疗. 中国胸心血管外科临床杂志, 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, 郑新瑞, 等. 非计划二次手术监控的实践与思考. 中国医院, 2013, 17(8): 26-27.
2. 王志强, 谢宗涛, 蔡铭, 等. 36 例食管贲门癌术后二次手术临床分析. 现代肿瘤医学, 2009, 17(2): 268-269.
3. 杨永波, 闫万璞, 熊宏超, 等. 食管癌二次手术 19 例原因分析. 中华胃肠外科杂志, 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. 黄伟钊, 吴颖猛, 叶红雨, 等. 食管癌术后消化道瘘的个体化治疗. 中国胸心血管外科临床杂志, 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. 徐凯, 谢宏亚, 马海涛, 等. 胸腔内食管-胃吻合口瘘诊治新模式初步研究结果.中华外科杂志, 2016, 54(2): 114-118.
10. 林海平, 李萍, 池嘉昌, 等. 食管癌术后胸内吻合口瘘的精确引流. 中国胸心血管外科临床杂志, 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. 孙志勇, 富皓白, 曹子昂, 等.带膜食管支架置入治疗食管癌术后胸内食管吻合口瘘. 中国胸心血管外科临床杂志, 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. 杨光煜, 何苡, 胡为才, 等. 53 例食管癌贲门癌术后吻合口瘘及相关并发症的处理. 中华胸心血管外科杂志, 2014, 30(1): 11-13.
16. 刘海峰, 王献增, 付金书, 等. 胸内食管胃吻合口瘘再手术治疗的临床分析.中国胸心血管外科临床杂志, 2014, 21(6): 836-838.
17. 李敏杰, 段红兵, 傅成国, 等. 食管癌术后 27 例胸胃瘘临床分析. 中华胸心血管外科杂志, 2013, 29(3): 136-137.
18. 吴晓峰, 毛志福, 吴江波, 等. 食管癌切除胃代食管术后胸胃瘘发生的预防和手术治疗. 海南医学, 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. 耿国军, 于修义, 郭崴, 等. 术前口服橄榄油预防腔镜食管癌切除术后乳糜胸的疗效分析. 中国胸心血管外科临床杂志, 2016, 23(7): 710-713.
22. 立伟, 何明, 陈龙奇, 等. 食管癌术中胸导管预防结扎连续 1031 例无乳糜胸手术经验. 中国肿瘤临床, 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. 熊辉, 张学华, 晏大学. 食管癌术后乳糜胸的治疗. 中国胸心血管外科临床杂志, 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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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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