Laliotis A, Hettiarachchi T, Rashid F, Hindmarsh A, Sujendran V
Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust , Hills Rd, Cambridge , UK.
Luton and Dunstable University Hospital NHS Foundation Trust, Department of Surgery , Luton , UK.
Ann R Coll Surg Engl. 2018 Aug 16;100(8):e1-e3. doi: 10.1308/rcsann.2018.0134.
Surgical management of oesophageal and gastro-oesophageal junction malignancies is one of the most challenging situations confronting the surgeon. Attaining a complete circumferential resection margin of lower-third oesophageal and gastro-oesophageal junction locally advanced carcinomas requires en-bloc resection of the hiatus and all the peri-oesophageal tissue and pleura. This results in an increased risk of herniation of the abdominal organs through the enlarged hiatus, which carries significant risk of morbidity and mortality. The incidence of this complication is higher than has been reported. Surgical management of symptomatic hernias is the standard treatment while criteria for managing asymptomatic hernias are less clear. We report a rare case of a late mediastinal herniation of the pancreas and bile duct, leading to obstructive jaundice following oesophagectomy which was treated successfully in our unit.
食管及食管胃交界部恶性肿瘤的外科治疗是外科医生面临的最具挑战性的情况之一。对于食管下三分之一段及食管胃交界部局部进展期癌，要获得完整的环周切除切缘，需要将裂孔及所有食管周围组织和胸膜整块切除。这会增加腹部器官通过扩大的裂孔发生疝出的风险，而这种疝出具有显著的发病和死亡风险。该并发症的发生率高于已报道的情况。有症状疝的外科治疗是标准治疗方法，而无症状疝的处理标准则不太明确。我们报告了一例罕见的胰腺和胆管迟发性纵隔疝，该疝导致食管切除术后出现梗阻性黄疸，在我们科室成功得到治疗。
