Miyazaki Tatsuya, Inose Takanori, Tanaka Naritaka, Suzuki Shigemasa, Hara Keigo, Ozawa Daigo, Yokobori Takehiko, Sakai Makoto, Souda Makoto, Fukuchi Minoru, Kuwano Hiroyuki
Department of General Surgical Science, Gunma University, Maebashi, Japan.
Kyobu Geka. 2013 Jul;66(8 Suppl):762-6.
We reviewed the indications for re-thoracotomy after esophagectomy for esophageal cancer. Hemothorax, chylothorax, tracheobronchial injury (fistula), pneumothorax, and pyothorax were the main causes of re-thoracotomy. Indications for emergency thoracotomy were as follows. 1)Hemothorax:bleeding through the chest drain continuing at >100 ml/hour for ≥5 hour, or in cases when normal blood pressure cannot be maintained without blood transfusion. 2)Chylothorax:in cases with ≥1.5 l/day of chyle drainage for >5 days under conservative treatment. Healing is not seen for 14 days after conservative treatment. Nutritional status of the patient has worsened. 3)Tracheobronchial injury:at 1st respiration state should be understood. After we maintain the patient's airway, fistula is treated by closure and plombage with omentum or muscle flap. Appropriate diagnosis and timing are important for re-thoracotomy for complications after esophagectomy.
我们回顾了食管癌食管切除术后再次开胸手术的指征。血胸、乳糜胸、气管支气管损伤(瘘)、气胸和脓胸是再次开胸手术的主要原因。急诊开胸手术的指征如下。1)血胸:胸腔引流管持续出血>100毫升/小时达≥5小时,或在不输血就无法维持正常血压的情况下。2)乳糜胸:保守治疗下乳糜引流量≥1.5升/天持续>5天。保守治疗14天后未见愈合。患者营养状况恶化。3)气管支气管损伤:首先应了解呼吸状态。在维持患者气道后,通过缝合并用网膜或肌瓣填充来治疗瘘。对于食管切除术后并发症的再次开胸手术,恰当的诊断和时机很重要。