van Sandick J W, Knegjens J L, van Lanschot J J, Obertop H
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Br J Surg. 1999 Jan;86(1):109-12. doi: 10.1046/j.1365-2168.1999.00979.x.
Intrathoracic herniation of abdominal viscera is a potentially life-threatening condition, especially when diagnosis is delayed. The aim of this study was to estimate its incidence following oesophageal resection and to define contributing factors that might influence its occurrence.
All radiographic studies of the chest that were made during follow-up in a series of 218 patients who underwent oesophagectomy between 1993 and 1997 were reviewed.
Herniation of bowel alongside the oesophageal substitute was detected in nine patients (4 per cent). Four hernias occurred within the first week after operation and five were detected at late follow-up. Surgical treatment was indicated in six patients. Analysis of predisposing factors revealed that extended incision and partial resection of the diaphragm were associated with an increased risk of postoperative hernia formation (four of 29 following extended enlargement versus five of 189 after routine opening of the oesophageal hiatus; P = 0.02).
Diaphragmatic herniation was found in 4 per cent of patients after oesophagectomy. After extended iatrogenic disruption of the normal hiatal anatomy, narrowing of the diaphragmatic opening may be indicated to avoid postoperative herniation of bowel into the chest. Awareness of its possible occurrence may help prevent the development of intestinal obstruction and strangulation.
腹腔脏器胸腔内疝是一种潜在的危及生命的疾病，尤其是诊断延迟时。本研究的目的是评估食管切除术后其发生率，并确定可能影响其发生的相关因素。
回顾了1993年至1997年间接受食管切除术的218例患者随访期间进行的所有胸部影像学检查。
9例患者（4%）发现肠管在食管替代物旁疝出。4例疝发生在术后第一周内，5例在随访后期发现。6例患者接受了手术治疗。对易感因素的分析显示，扩大切口和部分膈肌切除术与术后疝形成风险增加相关（扩大扩大术后29例中有4例，食管裂孔常规打开后189例中有5例；P = 0.02）。
食管切除术后4%的患者发生膈肌疝。在正常裂孔解剖结构受到医源性广泛破坏后，可能需要缩小膈肌开口以避免术后肠管疝入胸腔。认识到其可能发生有助于预防肠梗阻和绞窄的发生。
