摘要
目的总结全腔镜下食管癌根治术对呼吸系统的损伤及围术期并发症的发病原因,探讨防治策略。方法回顾2012年7月—2013年7月在我科行全腔镜下食管癌根治术并出现呼吸系统损伤及相关并发症16例的临床资料,总结围术期呼吸系统损伤及相关并发症的发病原因和临床特点。结果全组均为全腔镜下食管癌切除+食管-管状胃颈部吻合术,开展腔镜手术初始阶段的5例术中采用双腔支气管插管,其中2例术中发生气管、支气管损伤,在腔镜下完成修补,术后康复;后期行手术的11例均在单腔气管插管+人工气胸下实施手术,均未发生气管损伤。全组无中转开胸及开腹手术。本组术后14例出现并发症,其中声音嘶哑并肺部感染3例,经喉镜检查证实为左侧声带麻痹,予保守治疗后康复出院;乳糜胸伴大量胸腔积液3例,其中1例予保守治疗,2例再次于胸腔镜下结扎胸导管,均成功治愈;单纯肺部感染4例,予抗感染治疗后痊愈;严重肺部感染并呼吸功能衰竭4例,均行气管切开、呼吸机辅助呼吸,其中1例予保守治疗痊愈,余3例合并吻合口瘘,经食管瘘口及胸管引流治愈,1例最终因并发气管-食管瘘救治无效死亡。结论呼吸系统损伤是全腔镜下食管癌根治术围术期主要并发症,围术期雾化、术中单腔气管插管+人工气胸、注意神经保护等措施是预防损伤的关键。
Objective To summarize the damage to the respiratory system and the cause of perioperative complications by combined usage of the laparoscopic and thoracoscopic esophagectomy and discuss the strategy of prevention and treatment. Methods Clinical data of 16 patients,undergoing a minimally invasive esophagogastectomy in our department and with damage to the respiratory system and related complications during July 2012 and July 2013 were recalled. The factors of harm to the respiratory system,complications and clinical features during the perioperative period were summed up. Results The complete surgical method was excision of esophageal cancer with the laparoscopic and thoracoscopic and anastomotic operation of oesophagus-tubulous stomach at the neck. In the early stage,5 cases of operation applied double lumen tube intubation,and 2 of them had the damage to trachea and bronchus during the cannula of dual cavity bronchus. We finished the repair under the thoracoscope,and the patients recovered to normal conditions after operation; the other 11 patients underwent the operations of single-lumen endotracheal tube and artificial pneumothorax,with no obvious damage to respiratory system. In this group there was no transit thoracotomy or laparotomy. 14 cases of this group suffered from postoperative complications,and 3 patients had hoarse voices and concurrent pulmonary infection. The laryngeal mirror proved that it was paralysis of left vocal cord. They recovered and were discharged after conservative treatment. 3cases had chylopleura and a great amount of hydrothorax,1 case received the expectant treatment,the other 2 had ligatured the ductus thoracicus under the thoracoscope again,and both of them were successfully cured. 4 cases had simply pulmonary infection,and were successfully cured after administration of antibiotics,the other 4 cases suffered from the severe pulmonary infection complicated by prostration of respiratory function. The trachea was cut open and the breathing machine was used for assisted respiration,1 case was given conservative treatment to heal,3 cases had anastomotic fistula,and were cured using the esophageal fistula tube and the chest tube drainage. The remaining 1 patient had the complicated trachea-esophageal fistula and died. Conclusion The damage to respiratory system is a vital complication caused by combined usage of the laparoscopic and thoracoscopic esophagectomy during the perioperative period,which could be prevented by perioperative atomization and single-lumen endotracheal tube and artificial pneumothorax and more attention should be paid to the nerve protection in intraoperative period.
出处
《临床误诊误治》
2016年第3期63-66,共4页
Clinical Misdiagnosis & Mistherapy
关键词
食管肿瘤
胸腔镜检查
腹腔镜检查
创伤和损伤
呼吸系统
围手术期
Esophageal neoplasm
Thoracoscopy
Laparoscopy
Wound and injury
Respiratory system
Perioperative period
作者简介
通讯作者：刘灿辉，E-mail：chliu84@163．com
