Fujiwara Satoshi, Goto Masakazu, Inoue Seiya, Sumitomo Hiroyuki, Izaki Fuyumi, Takeuchi Taihei, Inui Tomohiro, Sakamoto Shinichi, Misaki Mariko, Kawakita Naoya, Yoshida Takahiro, Toba Hiroaki, Takizawa Hiromitsu
Department of Thoracic, Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
J Med Invest. 2025;72(1.2):189-193. doi: 10.2152/jmi.72.189.
We report a case of delayed gastric conduit emptying (DGCE) after surgery for esophageal cancer. A 67-year-old man who visited a hospital because of dysphagia and was referred for a diagnosis of esophageal cancer. Contrast-enhanced computed tomography (CT) showed wall thickening of the middle thoracic esophagus and an enlarged abdominal lymph nodes and a spiculated pulmonary shadow 25×20 mm in size in right lower lobe that was highly suspected as a primary lung cancer. Preoperative chemotherapy was introduced due to advanced esophageal cancer, both the esophageal tumor and the pulmonary lesion were found to be shrunk. Even after a detailed examination, the shadow in the right lower lobe of the lung could not be ruled out for malignancy, a simultaneous surgery was conducted. The patient underwent S10 segmentectomy followed by subtotal esophagectomy and the posterior mediastinal route reconstruction using a gastric conduit. Gastrografin radiography revealed stasis of the reconstructed gastric conduit on postoperative day (POD) 8. CT and upper gastrointestinal endoscopy showed that the gastric conduit was pulled into the right thoracic cavity caused by pulmonary resection and developed inflammatory changes, causing DGCE. The DGCE eventually improved with conservative treatment and the patient was discharged on POD 68. J. Med. Invest. 72 : 189-193, February, 2025.
我们报告一例食管癌手术后延迟性胃代食管排空（DGCE）的病例。一名67岁男性因吞咽困难就诊，被转诊以诊断食管癌。对比增强计算机断层扫描（CT）显示胸段食管中段壁增厚、腹部淋巴结肿大，右肺下叶有一个大小为25×20 mm的毛刺状肺阴影，高度怀疑为原发性肺癌。由于食管癌晚期，患者接受了术前化疗，食管肿瘤和肺部病变均缩小。即使经过详细检查，右肺下叶的阴影仍不能排除恶性可能，遂进行了同期手术。患者接受了S10段切除术，随后行食管次全切除术，并采用胃代食管经后纵隔途径重建。泛影葡胺造影显示术后第8天（POD 8）重建的胃代食管出现淤滞。CT和上消化道内镜检查显示，胃代食管因肺切除被牵拉至右侧胸腔并发生炎症改变，导致DGCE。DGCE最终经保守治疗得到改善，患者于POD 68出院。《医学调查杂志》72: 189 - 193，2025年2月。
