Brenkman Hylke J F, Parry Kevin, Noble Fergus, van Hillegersberg Richard, Sharland Donna, Goense Lucas, Kelly Jamie, Byrne James P, Underwood Timothy J, Ruurda Jelle P
Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Hospital Southampton, Southampton, United Kingdom.
Ann Thorac Surg. 2017 Apr;103(4):1055-1062. doi: 10.1016/j.athoracsur.2017.01.026. Epub 2017 Mar 6.
Hiatal hernia (HH) after esophagectomy is becoming more relevant due to improvements in survival. This study evaluated and compared the occurrence and clinical course of HH after open and minimally invasive esophagectomy (MIE).
The prospectively recorded characteristics of patients treated with esophagectomy for cancer at 2 tertiary referral centers in the United Kingdom and the Netherlands between 2000 and 2014 were reviewed. Computed tomography reports were reviewed to identify HH.
Of 657 patients, MIE was performed in 432 patients (66%) and open esophagectomy in 225 (34%). A computed tomography scan was performed in 488 patients (74%). HH was diagnosed in 45 patients after a median of 20 months (range, 0 to 101 months). The development of HH after MIE was comparable to the open approach (8% vs 5%, p = 0.267). At the time of diagnosis, 14 patients presented as a surgical emergency. Of the remaining 31 patients, 17 were symptomatic and 14 were asymptomatic. An elective operation was performed in 10 symptomatic patients, and all others were treated conservatively. During conservative treatment, 2 patients presented as a surgical emergency. An emergency operation resulted in a prolonged intensive care unit stay compared with an elective procedure (3 vs 0 days, p < 0.001). In-hospital deaths were solely seen after emergency operations (19%).
HH is a significant long-term complication after esophagectomy, occurring in a substantial proportion of the patients. The occurrence of HH after MIE and open esophagectomy is comparable. Emergency operation is associated with dismal outcomes and should be avoided.
由于生存率的提高，食管癌切除术后的食管裂孔疝（HH）问题日益受到关注。本研究评估并比较了开放手术和微创食管癌切除术（MIE）后HH的发生率及临床病程。
回顾了2000年至2014年间在英国和荷兰两家三级转诊中心接受食管癌切除术患者的前瞻性记录特征。通过计算机断层扫描（CT）报告来确定HH。
657例患者中，432例（66%）接受了MIE，225例（34%）接受了开放食管癌切除术。488例患者（74%）进行了CT扫描。45例患者在中位时间20个月（范围0至101个月）后被诊断为HH。MIE后HH的发生率与开放手术相当（8%对5%，p = 0.267）。诊断时，14例患者表现为外科急症。其余31例患者中，17例有症状，14例无症状。10例有症状的患者接受了择期手术，其他患者均接受保守治疗。保守治疗期间，2例患者发展为外科急症。与择期手术相比，急诊手术导致重症监护病房住院时间延长（3天对0天，p < 0.001）。仅在急诊手术后出现院内死亡（19%）。
HH是食管癌切除术后一种重要的长期并发症，在相当比例的患者中发生。MIE和开放食管癌切除术后HH的发生率相当。急诊手术预后不佳，应避免。
