经左胸和胸腹腔镜联合食管癌术后并发膈疝的诊治和预防  

Diaphragmatic hernia after left-sided intrathoracic or combined laparoscopic and thoracoscopicesophagectomy

作　　者：陶文虎[1] 张仁泉[1] 刘晓[1] 

机构地区：[1]安徽医科大学第一附属医院普胸外科,合肥230022

出　　处：《癌症进展》2014年第4期370-374,共5页Oncology Progress

摘　　要：目的分析经左胸和胸腹腔镜联合食管癌术后膈疝的发生原因和临床特点,讨论其诊断防治方法。方法回顾性分析10例食管癌术后发生膈疝的临床资料。结果术后早期并发膈疝5例（术后1个月内）,远期5例（术后1-11年）。其中1例结肠穿孔,行结肠造口术,术后死于呼吸衰竭;6例经手术治愈;1例放弃手术治疗;2例无明显症状,未予手术治疗。结论食管癌术后膈疝是一种少见而严重的并发症,经左胸径路和胸腹腔镜联合经右胸径路均可发生,其发生与手术操作不当、微创技术的应用导致腹膜粘连减少、术后腹压增加及患者自身体质等因素有关,重在预防,早期诊断、及时手术是防止肠坏死、减少死亡率的有效方法。Objective To evaluate the clinical features of diaphragmatic hernia after left-sided intrathoracic or combined laparoscopic and thoracoscopic esophagectomy, and to discuss its diagnose, treatment and preventive measures. Method The clinical data of 10 cases of diaphragmatic hernia after esophagectomy were analyzed retrospectively. Result 5 early cases occurred within 30 days and 5 late cases occurred within 1 – 11 years after operation.There was one case of strangulated hernia with colon perforation who then underwent colostomy, and eventually died from respiratory failure. 6 cases were cured after hernioplasty. One case refused the recommended reoperation.Two cases were asymptomatic, and no surgical repair was performed. Conclusion Diaphragmatic hernia after esophagectomy is a rare but severe complication, it can occur after left-sided intrathoracic or combined laparoscopic and thoracoscopic esophagectomy. The reasons for its occurrence consist of technical defects, less peritoneal adhesions due to the more frequent use of minimally invasive procedures in esophageal surgery, increased intraabdominal pressure and the patient＇s predisposition. Preventive measures and early diagnosis is very important. Once diagnosed, it should be treated surgically to prevent strangulation of colon and small bowel as well as to reduce mortality.

关 键 词：膈疝 食管癌 术后并发症 

分 类 号：R735.1[医药卫生—肿瘤]