Izumi Daisuke, Watanabe Masayuki, Nagai Yohei, Harada Kazuto, Imamura Yu, Iwagami Shiro, Miyamoto Yuji, Iwatsuki Masaaki, Baba Yoshifumi, Baba Hideo
Fukuoka Igaku Zasshi. 2014 Jan;105(1):11-5.
We herein report a case of mediastinitis with left pyothorax due to anastomotic leakage after totally laparoscopic proximal gastrectomy (TLPG) successfully managed by T-tube placement and intercostal muscle flap reinforcement. A 51-year-old man, who had undergone a TLPG at a referring hospital, was referred for fever, elevated inflammation markers, and pleural effusion on postoperative day 3. A computed tomography (CT) scan revealed mediastinitis with left pyothorax caused by anastomotic leakage. An emergency operation was performed through a left thoracotomy. After an irrigation of the thoracic cavity and a decortication of the pleura, we found a perforation in the left side of the anastomosis. We decided to insert a T-tube through the perforation and performed intercostal muscle flap reinforcement. He got acute respiratory distress syndrome but recovered after treatment in Intensive Care Unit for 24 days. Oral intake was started on day 45 and he was discharged on day 71. A T-tube drainage and wrapping with the intercostal muscle flap is a useful choice of treatment for intrathoracic anastomotic leakage with severe inflammation.
我们在此报告一例全腹腔镜近端胃切除术（TLPG）后因吻合口漏导致纵隔炎合并左侧脓胸的病例，该病例通过放置T管和肋间肌瓣加固成功治疗。一名51岁男性，在转诊医院接受了TLPG手术，术后第3天因发热、炎症指标升高和胸腔积液被转诊。计算机断层扫描（CT）显示由吻合口漏引起的纵隔炎合并左侧脓胸。通过左胸切开术进行了急诊手术。在对胸腔进行冲洗和胸膜剥脱后，我们发现吻合口左侧有穿孔。我们决定通过穿孔插入T管并进行肋间肌瓣加固。他出现了急性呼吸窘迫综合征，但在重症监护病房治疗24天后康复。术后第45天开始经口进食，第71天出院。T管引流和肋间肌瓣包裹是治疗伴有严重炎症的胸内吻合口漏的一种有效治疗选择。
