Kishimoto Yutaka, Otsuka Koji, Yamashita Takeshi, Saito Akira, Kohmoto Masahiro, Motegi Kentaro, Ariyoshi Tomotake, Goto Satoru, Murakami Masahiko, Aoki Takeshi
Department of Gastrointestinal and General Surgery, School of Medicine, Showa University, Tokyo, Japan.
Esophageal Cancer Center, Showa University Hospital, 1-5-8, Hatanodai, Sinagawa-ku, Tokyo, 142-8666, Japan.
Esophagus. 2025 Mar 20. doi: 10.1007/s10388-025-01119-6.
Gastric tube prolapse into the thoracic cavity in retrosternal route reconstruction during esophagectomy is known as intrathoracic herniation of the gastric tube (IHGT). However, few reports have determined whether a correlation exists between IHGT and postoperative complications. Moreover, the optimal procedure for avoiding IHGT remains unclear.
This retrospective study included 200 patients who had undergone subtotal esophagectomy and retrosternal gastric tube reconstruction at a single institution. The diagnosis of IHGT was defined as a gastric tube herniation length of ≥ 5 cm on plain chest radiography. The frequency of postoperative complications in patients with IHGT was measured to determine any correlation. The incidence of IHGT in a laparoscopic retrosternal route creation group was also measured and the efficacy of this procedure was investigated.
The overall incidence of IHGT was 7.5%. The incidence of grade II or higher anastomotic leakage and atelectasis was significantly higher in the IHGT( +) (anastomotic leakage, 26.7% vs. 4.3%, P = 0.007; atelectasis, 40.0% vs. 13.5%, P = 0.016). In univariate analysis, IHGT( +) showed a significantly higher incidence of anastomotic leakage (OR 7.88, P = 0.007). In multivariate analysis, IHGT was an independent risk factor for atelectasis (OR 5.03, P = 0.005). Furthermore, the incidence of IHGT was significantly lower in the laparoscopic group (2.0% vs. 13.0%, P = 0.005).
Our findings show that IHGT may be correlated with grade II or higher anastomotic leakage and atelectasis. Laparoscopic retrosternal route creation may be effective in avoiding IHGT and contributes to a reduction in postoperative complications.
在食管切除术中经胸骨后途径重建时胃管脱垂至胸腔被称为胃管胸腔内疝（IHGT）。然而，很少有报告确定IHGT与术后并发症之间是否存在关联。此外，避免IHGT的最佳手术方法仍不明确。
这项回顾性研究纳入了在单一机构接受食管次全切除术和胸骨后胃管重建的200例患者。IHGT的诊断定义为胸部X线平片上胃管疝出长度≥5 cm。测量IHGT患者术后并发症的发生率以确定是否存在任何关联。还测量了腹腔镜胸骨后途径创建组中IHGT的发生率，并研究了该手术方法的疗效。
IHGT的总体发生率为7.5%。IHGT（+）组中II级或更高等级吻合口漏和肺不张的发生率显著更高（吻合口漏，26.7%对4.3%，P = 0.007；肺不张，40.0%对13.5%，P = 0.016）。在单因素分析中，IHGT（+）显示吻合口漏的发生率显著更高（OR 7.88，P = 0.007）。在多因素分析中，IHGT是肺不张的独立危险因素（OR 5.03，P = 0.005）。此外，腹腔镜组中IHGT的发生率显著更低（2.0%对13.0%，P = 0.005）。
我们的研究结果表明，IHGT可能与II级或更高等级吻合口漏和肺不张相关。腹腔镜胸骨后途径创建可能有效地避免IHGT，并有助于减少术后并发症。
