Audebert A, Wind P, Sauvanet A, Douard R, Benichou J, Cugnenc P-H, Belghiti J
Service de chirurgie digestive, hôpital Avicenne AP-HP, université Paris-XIII, 125, route de Stalingrad, 93000 Bobigny, France.
Ann Chir. 2005 Jan;130(1):21-5. doi: 10.1016/j.anchir.2004.09.003.
Diaphragmatic hernia is a rare complication of oesophagectomy for cancer. We report a series of seven patients to determine characteristics of this entity.
Seven patients (six male and one female, 61 to 68 years old) were operated on for diaphragmatic hernia following oesophagectomy for carcinoma (adenocarcinoma N =4, squamous-cell carcinoma N =3). Oesophagectomy had been performed through abdominal transhiatal approach in four patients and transthoracically in three, with hiatal enlargement in all cases.
Three patients, all symptomatic, underwent emergency surgery within two years following oesophagectomy. Of the four patients operated between two and seven years after oesophagectomy, two were symptomatic. Presence of symptoms were neither related with technique of oesophagectomy, nor to type of hiatal enlargement (anterior, or by crura division). All patients with hernia containing small bowel were symptomatic. All patients were operated through abdominal approach. Hernia contained colon three times, small bowel once, and both three times. Hernia reduction needed additional phrenotomy in six patients. Two patients underwent colectomy to treat peroperative colonic ischemia. Diaphragmatic hiatus was calibrated around the gastric tube by direct suture in six patients or with absorbable mesh in one. There was no death. No recurrences occurred with a follow up ranging from one to five years.
The diaphragmatic hernia after oesophagectomy is due to excessive hiatal enlargement. Hernias occurring early after oesophagectomy are badly tolerated and need urgent reoperation. To prevent this complication of oesophagectomy, we advocate calibration of diaphragmatic hiatus fit to width of gastroplasty.
膈疝是食管癌切除术后一种罕见的并发症。我们报告一组7例患者，以确定该病症的特征。
7例患者（6例男性，1例女性，年龄61至68岁）因食管癌切除术后发生膈疝而接受手术（腺癌4例，鳞状细胞癌3例）。4例患者通过经腹经裂孔途径进行食管癌切除术，3例经胸手术，所有病例均有裂孔扩大。
3例有症状的患者在食管癌切除术后两年内接受了急诊手术。在食管癌切除术后2至7年接受手术的4例患者中，2例有症状。症状的出现既与食管癌切除技术无关，也与裂孔扩大的类型（前方或通过膈肌脚分开）无关。所有疝内容物为小肠的患者均有症状。所有患者均通过腹部途径进行手术。疝内容物为结肠3次，小肠1次，结肠和小肠同时存在3次。6例患者疝修补需要额外的膈切开术。2例患者接受结肠切除术以治疗术中结肠缺血。6例患者通过直接缝合在胃管周围校准膈裂孔，1例使用可吸收网片。无死亡病例。随访1至5年无复发。
食管癌切除术后膈疝是由于裂孔过度扩大所致。食管癌切除术后早期发生的疝耐受性差，需要紧急再次手术。为预防食管癌切除术的这种并发症，我们主张根据胃成形术的宽度校准膈裂孔。
