Chassot G, Robert J, Murith N, Spiliopoulos A
Clinique de chirurgie cardiovasculaire et thoracique, Hôpital Cantonal Universitaire de Genève, Suisse.
J Chir (Paris). 1997;134(9-10):432-5.
Description of a technical procedure to diminish the risk of spillage into the mediastinum in case of leakage from an intrathoracic anastomosis after partial esophagectomy.
In Ivor-Lewis procedures for cancer of the middle or lower third of the esophagus, the esogastric anastomosis is slipped under ther upper mediastinal pleura which is kept intact. From 1989 to 1997, this technique has been used in 43 consecutive patients (squamous carcinoma in 22, adenocarcinoma in 21). Three patients died postoperatively (7%) and complications (in 38%) were mostly pulmonary and cardiac. No anastomotic leak was detected on routine Gastrografin swallow performed on the 7th postoperative day. Three patients required dilation for stenosis.
Subpleural blanketing of intrathoracic anastomoses after esophagectomy is safe and easy to do, and should help diminish the consequences of possible anastomotic leakage.
描述一种技术操作，以降低部分食管切除术后胸内吻合口漏液时漏入纵隔的风险。
在针对食管中下段癌的艾弗-刘易斯手术中，将食管胃吻合口置于完整保留的上纵隔胸膜下方。1989年至1997年，该技术连续应用于43例患者（22例为鳞状细胞癌，21例为腺癌）。3例患者术后死亡（7%），并发症发生率为38%，主要为肺部和心脏并发症。术后第7天常规行泛影葡胺吞咽检查未发现吻合口漏。3例患者因狭窄需要扩张。
食管切除术后胸内吻合口的胸膜下覆盖安全且易于操作，应有助于减轻可能的吻合口漏的后果。
