Dapri G, Himpens J, Mouchart A, Ntounda R, Claus M, Dechamps Ph, Hainaux B, Kefif R, Germay O, Cadière G B
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.
Surg Endosc. 2007 Dec;21(12):2322-5. doi: 10.1007/s00464-007-9559-3. Epub 2007 Aug 25.
Esophago-gastric necrosis is a surgical emergency associated with high morbidity and mortality. We report a laparoscopic transhiatal esophago-gastrectomy performed on a 43-year-old male, presenting two hours after hydrochloric acid ingestion. A gastroscopy showed several oral mucosal ulcers, a significant edema of the pharynx and larynx, a necrosis of the middle and lower esophagus and of the gastric fundus and antrum. A conservative strategy with intensive care observation was initially followed. After a change of clinical signs, chest-abdominal computed tomography was realized and a pneumoperitoneum with free fluid in the left subphrenic space and bilateral pleural effusions was in evidence. A laparoscopic exploration was proposed to the patient, and confirmed the presence of free peritoneal fluid and necrosis with perforation of the upper part of the stomach. A laparoscopic total gastrectomy with subtotal esophagectomy was performed; the procedure finished with an esophagostomy on the left side of the neck and a laparoscopic feeding jejunostomy (video). Total operative time was 235 minutes. After six months a digestive reconstruction with esophagocoloplasty by laparotomy and cervicotomy was easily realized thanks to the advantages (few adhesions, bloodless, and simple colic mobilization) of the previous minimally invasive surgery.
食管胃坏死是一种与高发病率和死亡率相关的外科急症。我们报告了一例对一名43岁男性进行的腹腔镜经裂孔食管胃切除术，该患者在摄入盐酸两小时后就诊。胃镜检查显示有多处口腔黏膜溃疡、咽喉部明显水肿、食管中下段及胃底和胃窦坏死。最初采取了重症监护观察的保守策略。临床症状改变后，进行了胸腹部计算机断层扫描，发现有气腹，左膈下间隙有游离液体，双侧胸腔积液。建议患者进行腹腔镜探查，结果证实存在游离腹腔积液以及胃上部坏死并穿孔。遂行腹腔镜全胃切除术及食管次全切除术；手术最后在颈部左侧行食管造口术及腹腔镜空肠造口术（视频）。总手术时间为235分钟。六个月后，由于先前微创手术的优势（粘连少、无出血、结肠游离简单），通过剖腹术和颈部切开术轻松实现了食管结肠吻合术的消化重建。
