Clinical analysis of uncommon complications in esophageal and cardiac cancer operations
-
摘要:
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。 Abstract: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 embolism after operation should be monitored. 7) Thoracic gastric mediastinal hernia would cause serious consequences if treatment was not taken at a proper time. -
Key words:
- cancer /
- esophagus and cardia /
- rare complications
-
图 1 食管床内的胸胃于主动脉弓下方已部分疝入右胸
Figure 1. Thoracic stomach in esophageal bed had partly herniated into the right chest below the aortic arch
图 2 食管床内的胸胃已全部疝入右胸
Figure 2. Thoracic stomach in esophageal bed had completely herniated into the right chest
-
[1] 施开炯, 赵璐, 王衡, 等.食管癌术后左胸胃纵隔疝1例[J].中国肿瘤临床, 2008, 35(20):1200. http://journal11.magtechjournal.com/Jwk_zgzllc/CN/abstract/abstract10894.shtmlShi KJ, Zhao L, Wang H, et al. Left thoracic gastric mediastinal hernia after resection of esophageal carcinoma in 1 cases[J]. Chin J Clin Oncol, 2008, 35(20):1200. http://journal11.magtechjournal.com/Jwk_zgzllc/CN/abstract/abstract10894.shtml [2] 任光国, 周允中, 主编.胸外科手术并发症的预防和治疗[M].北京: 人民卫生出版社, 2004: 336-337.Ren GG, Zhou YH. Prevention and treatment of complications of operation in the Department of thoracic surgery[M].Beijing: People's Medical Publishing House, 2004: 336-337. [3] 施开炯, 赵璐, 王衡.食管癌、贲门癌术后吻合口瘘的防治[J].蚌埠医学院学报, 2001, 26(5): 242-243. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=bbyxyxb200103031Shi KJ, Zhao L, Wang H. Prevention of anastomotic fistula after esophagectomy for esophageal and cardiac cancer[J].Journal of Bengbu Medical College, 2001, 26(5):242-243. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=bbyxyxb200103031 [4] 施开炯, 赵璐, 王衡, 等.食管重建术后吻合口瘘31例临床分析[J].安徽医学, 2005, 26(4): 314-315. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=ahyx200504027Shi KJ, Zhao L, Wang H, et al. Clinical analysis of 31 cases of anastomotic fistula in postoperative esophageal reconstruction[J]. Anhui Medical Journal, 2005, 26(4):314-315. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=ahyx200504027 [5] 施开炯, 赵璐, 王衡, 等.食管及贲门癌切除术后吻合口主动脉瘘5例报道[J]中国肿瘤临床, 2006, 33(10):595-596. http://journal11.magtechjournal.com/Jwk_zgzllc/CN/abstract/abstract12484.shtmlShi KJ, Zhao L, Wang H, et al. Aortic fistula anastomosis in resection of esophageal and cardia carcinoma after a report of 5 cases[J]. Chin J Clin Oncol, 2006, 33(10):595-596. http://journal11.magtechjournal.com/Jwk_zgzllc/CN/abstract/abstract12484.shtml [6] 王福顺, 张少为, 田子强, 等.食管癌、贲门癌切除术后食管胃大动脉瘘的防治[J].食管外科, 2006, 5(2):72-73. http://cpfd.cnki.com.cn/Article/CPFDTOTAL-HNKA200509001114.htmWang FS, Zhang SW, Tian ZQ, et al. Prevention and treatment of esophagogastric arterial fistula resection of esophageal and cardiac cancer[J].Surgery of the Esophague, 2006, 5(2):72-73. http://cpfd.cnki.com.cn/Article/CPFDTOTAL-HNKA200509001114.htm [7] 杨国涛, 王善政, 丛旭滋, 等.食管癌切除术后并发食管胃主动脉瘘5例[J].中华胸心血管外科杂志, 1998, 14(6):364. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhxxxgwk199806025Yang GT, Wang SZ, Ccong XZ, et al. 5 cases of fistula complicated with gastroesophageal aorta after resection of esophageal carcinoma[J].Chinese Journal of thoracic and cardiovascular surgery, 1998, 14(6):364. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhxxxgwk199806025 [8] 卫功铨, 主编.食管外科手术技巧[M].合肥: 中国科学技术大学出版社, 2000: 270-271.Wei GQ. Esophageal surgical operation skills[M]. HEFEI: University of Science and Technology of China press, 2000: 270-271. [9] 王其彰, 主编.食管外科[M].北京: 人民卫生出版社, 2005.702-703.Wang QZ. Surgery of the Esophague[M]. Beijing: People's Medical Publishing House, 2005, 702-703. [10] 王其彰.食管外科并发症的可预防性[J].食管外科, 2007, 6(3):98-103. http://d.wanfangdata.com.cn/conference/6532566Wang QZ. Complications of esophageal surgery to prevent[J]. Surgery of the Esophague, 2 007, 6(3):98-103. http://d.wanfangdata.com.cn/conference/6532566 [11] Okita R, Mukaida H, Takiyama W, et al. Successful Surgical treatment of aortoesophageal fistula after esophagectomy[J].Ann Thorac Surg, 2005, 79(3):1059-1061. doi: 10.1016/j.athoracsur.2003.09.116 [12] 张逊.我国食管外科现状分析[J]食管外科电子杂志, 2013, 1(1):16-21. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=sgwkdzzz201301006Zang X. Current status of esophageal surgery in China[J].Esophageal surgery electronic magazine, 2013, 1(1):16-21. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=sgwkdzzz201301006 [13] 邓怡, 陈晓品.恶性肿瘤相关静脉血栓栓塞症的研究进展[J]临床肿瘤学杂志, 2013, 18(8):760-765. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lczlxzz201308022Deng Y, Chen XP. Research Progress on malignant tumor related to venous thromboembolism[J]. Journal of Clinical Oncology, 2013, 18(8):760-765. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lczlxzz201308022 [14] 李祺熠, 侯培勇, 苏奕明.急性肺动脉栓塞介入治疗49例临床体会[J].中国中医药咨讯, 2013, 4(5):116. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgzyyzx201205093Li QY, Hou PY, Su YM. Experience in treatment of 49 cases of clinical intervention of acute pulmonary embolism[J]. Chinese TCM information, 2013, 4(5):116. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgzyyzx201205093 [15] 朱其聪, 王亚辉, 余书勇.34例恶性肿瘤并发急性下肢深静脉血栓形成临床分析[J].肿瘤学杂志, 2013, 19(9):741-742. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zlxzz201309018Zhu QC, Wang YH, Yu SY. Clinical analysis of 34 cases of malignant tumor complicated with acute lower extremity deep venous thrombosis [J]. Journal of Oncology, 2013, 19(9):741-742. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zlxzz201309018 [16] 张炜浩, 郭志, 王长利, 等.恶性肿瘤合并静脉血栓栓塞症1例诊治分析[J].中国肿瘤临床, 2014, 41(4): 262-265. http://journal11.magtechjournal.com/Jwk_zgzllc/CN/abstract/abstract10203.shtmlZhang WH, Guo Z, Wang CL, et al. Clinical analysis of 1 cases of malignant tumor patients with venous thromboembolism[J]. Chin J Clin Oncol, 2014, 41(4):262-265. http://journal11.magtechjournal.com/Jwk_zgzllc/CN/abstract/abstract10203.shtml [17] 曹耀前, 钟殿胜.急性肺动脉栓塞介入治疗的研究现状[J]国际呼吸杂志, 2013, 33(14):1100-1103. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=gwyx-hxxt201314014Cao YQ, Zhong DS. Research status of interventional therapy in the treatment of acute pulmonary embolism[J]. International Journal of Cardiology, 2013, 33(14):1100-1103. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=gwyx-hxxt201314014 [18] 姚阳端.肺动脉栓塞介入治疗临床分析[J].中国实用医药, 2013, 8(3):83-84. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsyyy201303053Yao YD. Clinical analysis of interventional treatment of pulmonary embolism[J]. Chinese Practical Medicine, 2013, 8(3):83-84. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsyyy201303053 [19] 殷述刚, 曹健鹏, 黄梅, 等.上腔静脉滤器在肿瘤合并上肢深静脉血栓形成中的应用[J].中国肿瘤临床, 2013, 40(5):271-274. http://journal11.magtechjournal.com/Jwk_zgzllc/CN/abstract/abstract9441.shtmlYin SG, Cao JP, Huang M, et al. Cava filter chamber combined with upper extremity deep venous thrombosis in tumor[J]. Chin J Clin Oncol, 2013, 40(5):271-274. http://journal11.magtechjournal.com/Jwk_zgzllc/CN/abstract/abstract9441.shtml [20] 李勇, 王化勇, 王雷, 等.管状胃与全胃代食管术治疗食管癌的疗效比较[J].临床肿瘤学杂志, 2013, 18(8): 743-745. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lczlxzz201308018Li Y, Wang HY, Wang L, et al. Comparison of the efficacy of gastric tube with a full stomach replacement of esophagus in the treatment of esophageal carcinoma[J]. Journal of Clinical Oncology, 2013, 18(8):743-745. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lczlxzz201308018 -
下载:
点击查看大图
图(3)
计量
- 文章访问数: 40
- HTML全文浏览量: 17
- PDF下载量: 0
- 被引次数: 0
