CLINICAL ANALYSIS OF 32 CASES OF THORACIC STOMACH DILATATION AFTER ESOPHAGECTOMY VIA LEFT CERVICAL ROUTE ESOPHAGOGASTRIC ANASTOMOSIS
Xu Feng, Da zuowei* Department of Chest Surgery, Central hospital of Huangpu district, Shanghai 200002,China *Department of Thoraco Cardiac Surgery, Changzheng hospital,Shanghai 200003,China
Objective To discuss the cause,diagnosis and management principles of stomach dilatation after subtotal esophagectomy with left cervical route esophag-gastric anastomosis. Methods Petrospectively analyze the clinical materials of 32 cases of esophageal carcinoma undergoing left cervical route esophag-gastric anastomosis resulting thoracic gastric dilatation. Results 32 cases of this series were given fasting,re-inserting gastric tube to relieve the pressure until stability of the internal environment and getting recoved by supportive treatment. 3 among them were treated by enlargement of the original abdominal incision to make the esophageal hiatus relieved without any effect and then re-put the gastroenteric depression and recovered by nutritional support. The time for G-I depression was 14￣54 days,average 22 days. To stabilize the internal environment and give nutritional support, jejunostomy was performed in 11 cases, slender silicon tube was inserted via gastro- scope into duodenum to drop in nutrition. 16 cases received intravenous nutrition. Conclusions Post-operative esophageal carcinoma with stomach dilatation was mainly due to functional emptying distrubance. All should be treated conservatively except complete torsion of the stomach. When intravenous nutrition was not effective to stabilize the internal environment, it should be promptly use intestinal tract nutrition including jejunostomy, slender silicon tube insertion to supply nutrition. Re-operation to relieve the obstruction should be very careful.