Dumont P, Wihlm J M, Hentz J G, Roeslin N, Lion R, Morand G
Department of Thoracic Surgery, Hôpitaux Universitaires de Strasbourg 1, France.
Eur J Cardiothorac Surg. 1995;9(10):539-43. doi: 10.1016/s1010-7940(05)80001-6.
This study analyzes the respiratory complications in a retrospective study of 309 resections for esophageal cancer. We mainly performed two types of resections according to the height of the tumor: the Ivor-Lewis resection for middle thoracic lesions (182 cases), and the Akiyama resection for upper thoracic lesions (127 cases). We compared the respiratory complications occurring after these two procedures. Our overall mortality and morbidity rates were, respectively, 9% and 37%. In our series, the mortality rate was 4 times higher after the Akiyama procedure than after the Ivor-Lewis procedure, and the morbidity was twice as high. Respiratory complications accounted for 64% of the postoperative deaths. The Akiyama procedure yielded more respiratory complications, especially isolated bronchopneumonia and necrosis of the trachea or of the right or left main bronchus. Respiratory complications accounted for 53% of morbidity, mainly recurrent nerve paralysis with false passages and stasis in the transplant. Both are directly related to the surgical act and often result in bronchopneumonia. Rather than the surgical technique or the skill of the surgeon, it seems that local factors, such as the position of the tumor on the esophagus, increased the incidence of recurrent nerve paralysis following the Akiyama procedure. However, the rate of respiratory complications remained high after the Ivor-Lewis procedure. Patient history, which sometimes included a previous ENT cancer, must be taken into account, as well as the gravity of the operation and the duration of the intubation. Frequent false passages and reflux must be fought by intensive physiotherapy and, when necessary, by early tracheotomy before the patient develops postoperative acute respiratory distress syndrome.
本研究在一项对309例食管癌切除术的回顾性研究中分析了呼吸并发症情况。我们主要根据肿瘤高度进行了两种类型的切除术：针对胸中段病变的艾弗-刘易斯切除术（182例）和针对胸上段病变的秋山切除术（127例）。我们比较了这两种手术术后发生的呼吸并发症。我们的总体死亡率和发病率分别为9%和37%。在我们的系列研究中，秋山手术术后的死亡率比艾弗-刘易斯手术术后高4倍，发病率则高两倍。呼吸并发症占术后死亡病例的64%。秋山手术产生了更多的呼吸并发症，尤其是孤立性支气管肺炎以及气管或左右主支气管坏死。呼吸并发症占发病率的53%，主要是反复神经麻痹伴假道形成以及移植部位的淤滞。这两者都与手术操作直接相关，且常常导致支气管肺炎。似乎是诸如肿瘤在食管上的位置等局部因素，而非手术技术或外科医生的技能，增加了秋山手术术后反复神经麻痹的发生率。然而艾弗-刘易斯手术后呼吸并发症发生率仍然很高。必须考虑患者病史，其有时包括既往耳鼻喉科癌症，以及手术的严重程度和插管持续时间。必须通过强化物理治疗来应对频繁的假道形成和反流，必要时在患者发生术后急性呼吸窘迫综合征之前尽早进行气管切开术。
