CAJ | 학술논문

目的：探讨食管癌行二次手术的原因及防治措施。方法回顾性分析2000年1月至2012年12月间北京大学肿瘤医院单一手术组施行的946例食管癌手术患者的临床资料，其中19例因术后严重并发症需行二次手术，总结该19例患者的临床特点及治疗经过。结果19例二次手术的患者中因术后胸腔内出血行开胸止血术4例，因膈疝行膈疝还纳、膈肌修补术4例，因乳糜胸行胸导管结扎术4例，因腹部切口裂开行切口缝合术4例，因创伤性胰腺炎行胸腹腔探查、腹腔置管引流术1例，因肠梗阻行回盲部切除、回肠造瘘术1例，因双侧喉返神经麻痹行气管切开术1例。19例二次手术患者全部治愈，无围手术期死亡和再次并发症发生。结论食管癌术后再次手术常见原因主要为术后出血、膈疝、乳糜胸和腹部切口裂开。
목적：탐토식관암행이차수술적원인급방치조시。방법회고성분석2000년1월지2012년12월간북경대학종류의원단일수술조시행적946례식관암수술환자적림상자료，기중19례인술후엄중병발증수행이차수술，총결해19례환자적림상특점급치료경과。결과19례이차수술적환자중인술후흉강내출혈행개흉지혈술4례，인격산행격산환납、격기수보술4례，인유미흉행흉도관결찰술4례，인복부절구렬개행절구봉합술4례，인창상성이선염행흉복강탐사、복강치관인류술1례，인장경조행회맹부절제、회장조루술1례，인쌍측후반신경마비행기관절개술1례。19례이차수술환자전부치유，무위수술기사망화재차병발증발생。결론식관암술후재차수술상견원인주요위술후출혈、격산、유미흉화복부절구렬개。
Objective To investigate the cause and the management of treatment and prevention of reoperation following esophagectomy. Methods Clinical data of 946 cases with esophageal cancer undergoing esophagectomy from January 2000 to December 2012 by the same surgical team in the Beijing Cancer Hospital were retrospectively analyzed. Among them , 19 patients underwent reoperation after esophagectomy because of serious complications. Clinical features and treatment course of these 19 cases were summarized. Results The indications and procedures of reoperation included thoracotomy for hemorrhage (n=4), diaphragmatic hernia repair (n=4), thoracic duct ligation for chylothorax (n= 4), re-suturing for incision dehiscence (n=4), re-laparotomy and re-thoracotomy for drainage of traumatic pancreatitis (n=1), re-laparotomy for intestinal obstruction (n=1), and tracheotomy for bilateral recurrent laryngeal nerve paralysis(n=1). All the 19 patients were successfully cured without perioperative deaths and further complications. Conclusions The indications of reoperation following esophagectomy include postoperative bleeding, diaphragmatic hernia, chylothorax and abdominal incision dehiscence.