Adam D J, Thompson A M, Walker W S, Cameron E W
Department of Thoracic Surgery, City Hospital, Edinburgh, UK.
Br J Surg. 1996 Oct;83(10):1429-32. doi: 10.1002/bjs.1800831034.
A casenote review identified 18 patients with carcinoma of the oesophagus and gastric cardia who underwent transthoracic oesophagectomy after instrumental perforation. Oesophagectomy was performed within 48 h in ten patients (early surgery group) and after a median delay of 22 (range 5-48) days in eight patients (delayed surgery group). All patients underwent resection via left thoracolaparotomy with immediate intrathoracic anastomosis using the stomach in 17 of 18 patients. There were no anastomotic leaks. Significant postoperative complications occurred in five of ten of the early group with two in-hospital deaths and a mean survival of 551 days. Six of eight patients in the delayed group developed postoperative complications with two in-hospital deaths and a mean survival of 297 days. Transthoracic resection with immediate intrathoracic anastomosis can be performed without anastomotic leakage but there is high associated respiratory morbidity. The timing of oesophagectomy has little effect on hospital morbidity or mortality rates but early surgery is associated with better long-term survival.
一项病例记录回顾确定了18例食管和贲门癌患者，这些患者在器械穿孔后接受了经胸食管切除术。10例患者在48小时内接受了食管切除术（早期手术组），8例患者在中位延迟22天（范围5 - 48天）后接受了手术（延迟手术组）。所有患者均通过左胸腹部联合切口进行切除，18例患者中有17例使用胃立即进行胸内吻合。没有吻合口漏。早期组10例中有5例发生了严重的术后并发症，2例住院死亡，平均生存期为551天。延迟组8例患者中有6例出现术后并发症，2例住院死亡，平均生存期为297天。经胸切除并立即进行胸内吻合可以在无吻合口漏的情况下进行，但相关的呼吸系统发病率很高。食管切除术的时机对医院发病率或死亡率影响不大，但早期手术与更好的长期生存相关。
