摘要
目的分析胸腔镜下食管癌根治术中及术后近期并发症发生的原因和特点,总结防治方法。方法回顾性分析我院2013年1月至2015年1月165例行胸腔镜食管癌根治术患者的临床资料,其中男102例、女63例,年龄(67.9±8.3)岁。结果全组手术时间(275.3±50.2)min,术中失血量(230.0±110.5)ml,清扫淋巴结(18.1±6.5)枚,术后3 d胸腔引流量(750±550)ml。13例(7.8%)中转开胸,其中胸腔致密粘连6例(4.2%),出血2例(1.2%),心律失常2例(1.2%),氧合异常3例(1.8%)。术中17例(10.8%)发生并发症,包括心律失常2例(1.2%),氧合异常3例(1.8%),血管损伤出血7例(4.2%),胸导管损伤4例(2.4%),喉返神经损伤1例(0.6%)。术后发生并发症46例(27.8%),其中肺部感染23例(13.9%),声音嘶哑6例(3.6%),吻合口瘘4例(2.4%),切口感染3例(1.8%),残胃-气管瘘2例(1.2%),气胸2例(1.2%);术后非计划再次手术5例,其中乳糜胸3例(1.8%)、出血2例(1.2%);急性肺栓塞死亡1例(0.06%)。结论电视胸腔镜下食管癌根治术中导致中转开胸手术最常见原因是胸膜腔致密粘连、出血和心肺异常。术后最常见并发症包括肺部感染、声音嘶哑及颈部吻合口瘘,急性肺栓塞是胸外科术后死亡的重要原因。适当的预防措施可有效降低并发症的发生率。
Objective To evaluate the characteristics and reasons of complications in the patients with thoracoscopic esophagectomy.Methods We retrospectively analyzed the clinical data of 165 patients with thoracoscopic esophagectomy in our hospital from January 2013 through January 2015.There were 102 males and 63 females at average age of 67.9 ± 8.3 years.Results The operation time was 275.3 ± 50.2 min.The intraoperative blood loss was 230.0 ± 110.5 ml.The number of lymph node dissection was 18.1 ± 6.5.The volume of drainage in thoracic cavity was 750 ± 550 ml on the third day after operation.Thoracoscopic esophagectomy surgeries were successful except that 13 patients（7.8 %）converted to open operation including 6 patients（4.2 %）with severe pleural adhesion,2 patients（1.2 %）with hemorrhage,2 patients（1.2 %）with arrhythmia,and 3 patients（1.8 %）with abnormal oxygenation.There were 17 patients（10.8 %）were with intraoperative complications including 2 patients（1.2 %）with arrhythmia,3 patients（1.8 %）with abnormal oxygenation,7 patients（4.2 %）with hemorrhage caused by vascular injury,4 patients（2.4 %）with thoracic duct injury,1 patient（0.6 %）with recurrent laryngeal nerve injury.Moreover,46 patients（27.8 %）experienced postoperative complications including 23 patients（13.9 %）with pulmonary infection,6 patients（3.6 %）with hoarseness,4 patients（2.4 %）with anastomotic leakage,3 patients（1.8 %）with incision infection,2 patients（1.2 %）with tracheoesophageal fistula,and 2 patients（1.2 %）with pneumothorax.Unexpectedly,five patients underwent re-operation due to chylothorax（n= 3,1.8 %）and hemorrhage（n= 2,1.2 %）.One patient（0.06 %）died of acute pulmonary embolism.Conclusion Serious adhesion in abdominal cavity,abnormal of lung and heart.And bleeding are the main reasons caused transferring open thoracic surgery operation in patients with thoracoscopic esophagectomy.Lung infection,hoarseness,and anastomotic leakage of neck are the most common postoper
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2016年第4期352-356,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
食管癌
胸腔镜食管癌根治术
并发症
防治
Esophageal cancer
Thoracoscopic esophagectomy
Complications during and after operation
Prevention
