[食管切除术后的食管裂孔疝]。

Q4 Medicine Khirurgiya Pub Date : 2024-01-01 DOI:10.17116/hirurgia202411124
A B Ryabov, O V Pikin, V M Khomyakov, I V Kolobaev, N M Abdulkhakimov
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引用次数: 0

摘要

摘要分析食管癌切除术后食管裂孔疝的病因、手术治疗方法、手术技术特点及预防方法:我们回顾性分析了2018年至2023年间食管癌患者食管切除术后食管裂孔疝的发生率。对疝的结构、手术方案和术后效果进行了评估:我们分析了 161 名接受 Ivor Lewis(n=101)和 McKeown(n=60)食管切除术的患者(开刀手术 - 43.5%,胸腔镜和腹腔镜手术 - 23%,混合手术 - 33.5%)。术后食管裂孔疝的发生率为3.7%。疝气发生在1-15个月内。患者中有 5 名男性和 1 名女性(平均年龄 65 岁)。所有病例都对左侧膈嵴进行了部分或完全剥离。微创手术后疝气发生率为4.4%,开放手术后为2.9%。有两名(33.3%)患者在食管原发性手术后两个月内因回肠瘘接受了紧急手术。三名患者(50%)接受了选择性手术。一名患者(16.6%)目前正在接受随访。2例(33.3%)患者的并发症无症状。一名患者(16.6%)在COVID医院接受急诊手术后因绞窄性疝气和进行性呼吸衰竭而死亡。平均随访时间为 16 个月。结论:贲门疝发生率为 2.2%:结论:微创食管切除术后发生食管裂孔疝的几率是微创食管切除术的 2 倍。结论:微创食管切除术后发生食管裂孔疝的几率是微创食管切除术后的 2 倍。由于绞窄和紧急干预的风险很高,有症状的疝气必须采取积极的手术策略。在腹腔镜手术阶段,如果没有进行宽膈肌切开术、横断左侧膈肌皱襞和高腹压,这种并发症的发生率较低。
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[Hiatal hernia after esophagectomy].

Objective: To analyze the causes and surgical treatment of hiatal hernia after esophagectomy, technical features of surgery and methods of prevention.

Material and methods: We retrospectively analyzed the incidence of postoperative hiatal hernias after esophagectomy in patients with esophageal cancer between 2018 and 2023. Structure of hernias, surgical options and postoperative results were assessed.

Results: We analyzed 161 patients after Ivor Lewis (n=101) and McKeown (n=60) esophagectomies (open surge surgeries - 43.5%, thoraco- and laparoscopic procedures - 23%, hybrid procedures - 33.5%). The incidence of postoperative hiatal hernia was 3.7%. Hernia occurred within 1-15 months. There were 5 men and 1 woman (mean age 65 years). In all cases, partial or complete dissection of the left diaphragmatic crura was performed. The incidence of hernia after minimally invasive surgery was 4.4%, after open surgery - 2.9%. Two (33.3%) patients underwent urgent surgery for ileus within 2 months after primary esophageal surgery. Three (50%) patients underwent elective surgery. One (16.6%) patient is currently followed-up. The complication was asymptomatic in 2 (33.3%) patients. One (16.6%) patient died after emergency surgery in a COVID hospital due to strangulated hernia and progressive respiratory failure. Mean follow-up period was 16 months. No recurrent hernias were diagnosed.

Conclusion: Hiatal hernias occur 2 times more often after minimally invasive esophagectomies. Active surgical strategy is necessary for symptomatic hernias due to high risk of strangulation and emergency interventions. The incidence of this complication is lower without wide diaphragmotomy, transection of the left diaphragmatic crus and high abdominal pressure during laparoscopic stage.

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来源期刊
Khirurgiya
Khirurgiya Medicine-Medicine (all)
CiteScore
0.70
自引率
0.00%
发文量
161
期刊介绍: Хирургия отдельных областей сердце, сосуды легкие пищевод молочная железа желудок и двенадцатиперстная кишка кишечник желчевыводящие пути печень
期刊最新文献
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