胸腔镜辅助食管癌根治术后误吸并发症的发生机制

【摘要】 目的探讨胸腔镜辅助食管癌根治术后误吸并发症的发生机制及对策。方法回顾性分析了从1996年6月至2004年12月胸腔镜辅助食管癌根治术后发生误吸的18例病人的资料,对胃食管吻合部位,误吸发生时间,误吸发生的症状及处理方法进行分析。结果18例患者均行食管胃颈部吻合,误吸均发生在术后3个月内,误吸后均并发下肺的吸入性肺炎,其中发展为ARDS死亡3例,哮喘13例,顽固咳嗽5例。食管镜提示吻合口炎症僵硬18例,吻合口狭窄4例;胸片示胸胃过度膨胀致肺膨胀不全3例,双下肺感染18例。结论术中喉返、喉上神经损伤,术后大量进食、吻合口炎症、吻合口狭窄,胃动力障碍是患者产生误吸的主要原因。高龄患者误吸后容易引起吸入性肺炎、急性肺损伤或ARDS。更多还原

【Abstract】 Objective To probe in the mechanisms and strategies of postoperative aspiration of video-assisted thoracoscope radical correction of esophageal carcinoma. Methods We analysised retrospectively the data of 18 patiens who took place the postoperative aspiration following the video-assisted thoracoscope radical correction of esophageal carcinoma. Results All patients were done the cervical anastomosis and took place the aspiration in 3 months after operation. All patients got the infra-lobe pneumonitis. There were three patients died of ARDS following the pneumonitis, 13 patients happened the asthma , and 5 patients happened the refractory cough. We found all the patients had stiffness and inflammation at the stoma and there were 4 patients had the stenostomia with the endoscope examination. The chest X-ray film indicated there were 3 patients with overdistension of stomach and all the patients had the pneumonitis. Conclusions The injury of laryngeal nerve and nervus laryngeus superior, the inflammation of the stoma, the stenostomia, and the dyskinesis of stomach play important part in the happening of postoperative aspiration. There was a high mortality in older patients.更多还原