Gupta Vikas, Gupta Rajesh, Thingnam Shyam K S, Singh Rana S, Gupta Ashok K, Kuthe Sachin, Gupta Narendar M
Department of General Surgery (Division of Gastrointestinal Surgery), Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
J Gastrointest Surg. 2009 Mar;13(3):438-41. doi: 10.1007/s11605-008-0738-x. Epub 2008 Nov 11.
Tracheal laceration is a rare but life-threatening complication of esophagectomy. It is seen both with transhiatal and transthoracic esophagectomy.
Three hundred eighty-two esophagectomies were performed from 1998 to 2008. The medical records of five patients with laceration of trachea during esophagectomy managed at a tertiary care center were reviewed retrospectively.
There were three males and two females with age range 18-62 years. The overall incidence of tracheal laceration was 1.31%. Four lacerations (1.30%) occurred during transhiatal and one (1.35%) during transthoracic resection of esophagus. Tracheal laceration was detected intraoperatively in all. Laceration was long (>3 cm) in three patients and short (<2 cm) in two. Patients with long laceration required direct suturing, while those with short laceration could be managed with gastric reinforcement. No patient required additional thoracotomy to access the lesion. Two patients had pneumonia, one had recurrent nerve palsy, while another developed anastomotic disruption. No patient died.
Laceration of trachea is a potentially morbid complication of esophagectomy. Management should be individualized based on the extent and type of laceration. The surgical strategy depends upon the index procedure. The present series describes successful management of patients with tracheal injury associated with esophagectomy.
气管撕裂是食管切除术罕见但危及生命的并发症。经裂孔食管切除术和经胸食管切除术均可出现。
1998年至2008年共进行了382例食管切除术。回顾性分析了一家三级医疗中心收治的5例食管切除术中气管撕裂患者的病历。
患者共3男2女，年龄18 - 62岁。气管撕裂的总体发生率为1.31%。经裂孔食管切除术中发生4例（1.30%），经胸食管切除术中发生1例（1.35%）。所有气管撕裂均在术中被发现。3例患者的撕裂口较长（>3 cm），2例较短（<2 cm）。撕裂口长的患者需要直接缝合，而撕裂口短的患者可用胃加固处理。无一例患者需要额外开胸来处理病变。2例患者发生肺炎，1例出现喉返神经麻痹，另1例发生吻合口破裂。无患者死亡。
气管撕裂是食管切除术潜在的严重并发症。应根据撕裂的程度和类型进行个体化处理。手术策略取决于初次手术方式。本系列描述了食管切除术相关气管损伤患者的成功处理。
