Nagata C, Yano T, Hara S, Yoshitake A, Nakayama R, Terasaki H
Department of Anesthesiology, Kumamoto University, School of Medicine.
Masui. 2000 Jun;49(6):639-42.
A 71-year-old female with esophagohiatal hernia underwent a laparoscopic Nissen's fundoplication under general anesthesia. During the operation a Savary-Gilliard bougie was temporarily inserted to the esophagus to prevent esophagostenosis. After the emergence from anesthesia, the patient complained of severe back pain and developed tachypnea and a low SpO2 associated with an enlargement of mediastinal shadow on the chest X-ray, suggesting mediastinal perforation. Examination by endoscopy and thoracotomy revealed a pyriform sinus perforation reaching down to the mediastinum. This case demonstrates the possibility of accidental perforation by various devices inserted blindly to esophagus, especially during general anesthesia, and the importance of close observation of patients after the emergence from anesthesia.
一名患有食管裂孔疝的71岁女性在全身麻醉下接受了腹腔镜尼森胃底折叠术。手术过程中，临时插入一根萨瓦里-吉利扩张探条至食管以预防食管狭窄。麻醉苏醒后，患者主诉严重背痛，并出现呼吸急促和低氧饱和度，胸部X线显示纵隔阴影增大，提示纵隔穿孔。内镜检查和开胸手术发现梨状窦穿孔并累及纵隔。该病例表明，盲目插入食管的各种器械有意外穿孔的可能，尤其是在全身麻醉期间，同时也显示了麻醉苏醒后密切观察患者的重要性。
