食管癌和贲门癌切除术后膈疝24例临床病理分析

目的 :总结食管癌和贲门癌切除术后隔疝的临床特点 ,讨论其发生的原因。方法 :对我院自195 8以来 932 0例食管癌和贲门癌手术切除后发生的 2 4例隔疝的临床资料进行回顾分析。结果 :本组发生率为 0 2 6 %。在术后 4d内早期发生的 9例中 ,仅 1例出现相关症状 ,而在其余 15例中 11例有明显症状。本组 3例为绞窄性疝 ,4例为滑动疝。 2 1例通过正侧位胸片或床旁相确诊 ,2例通过钡餐灌肠确诊 ,1例则在因其他并发症二次开胸时发现。 2 3例行手术治疗 ,15例经胸部切口 ,6例经腹部切口 ,2例为胸腹联合切口。 2 1例修补成功 ,2例死于术后并发症 ,死亡率为 9 5 %。结论 :食管癌和贲门癌术后膈疝是一个相对少见 ,但有较高死亡率的并发症。术后早期出现的膈疝常缺乏典型的症状 ,及时清晰的床旁相是诊断的关键。膈疝一旦确诊 ,应及时手术 ,手术入路以经胸途径为佳。膈疝发生的原因既有手术操作的不当 ,也有患者自身素质的因素

Diaphragmatic Hernia Following Resection for Esophageal and Cardiac Carcinoma

Objective To evaluate the clinical features of diaphragmatic hernia following resection for esophageal and cardiac carcinoma and to discuss the reasons for its occurrence.Methods Retrospective analysis of the clinical manifestations of 24 cases of diaphragmatic hernia following 9 320 cases of resection for esophageal and cardiac carcinoma since 1958.Results The incidence in this series was 0 26%. Among the 9 early cases which occurred within 4 days after operation,only one case had suggestive symptom,on the contrary,among the rest 15 cases,11 had diagnostic symptoms;There were 3 cases of strangulated hernia and 4 cases of sliding hernia in this group.21 cases was diagnosed through chest film or bedside chest film,2 cases through barium enema examination,the last case was discovered on the second thoracotomy because of other complication.23 cases received hernioplasty,15 cases through thoracic approach,6 cases through abdominal approach,the other 2 cases through thoracoabdominal approach.21 cases achieved satisfying results,the other 2 cases died of postoperative complications,the mortality was 9 5%.Conclusions Diaphragmatic hernia following resection for esophageal and cardiac carcinoma is a rare complication,yet with relatively high mortality.Among the early cases,there is usually no suggestive symptom,the clear and timely bedside chest film is of vital importance to their diagnosis.Once diagnosed,it should be treated surgically,thoracic approach is recommended.The reasons for its occurrence consist of both technical defects and the patient's predisposition.