食管贲门癌术后膈疝10例临床分析

目的：评价食管癌、贲门癌术后膈疝的临床特征，探讨其诊断、治疗和预防方法。方法：回顾性分析我院1988以来876例食管癌和贲门癌手术切除后发生隔疝10例的临床资料。结果：膈疝发生率为1．14％，在术后5天内早期发生的3例中，仅1例出现相关症状，而在其余7例中，5例有明显症状。本组3例为绞窄性疝，4例为滑动疝。10例均通过正侧位胸片或床旁相确诊。10例行手术治疗，其中9例经胸部切口，1例经腹部切口。9例修补成功，1例死于术后并发症。结论：食管癌和贲门癌术后膈疝是相对少见，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。一旦确诊，应及时手术，手术入路以经胸途径为佳。

Diaphragmatic hernia following resection for esophageal and cardiac carcinoma :A report of 10 cases

Objective:To evaluate the clinical features of diaphragmatic hernia following resection for esophageal and cardiac carcinoma,and to discuss its diagnose,treatment and prophylaxis. Methods:Retrospective analysis of the clinical manifestations of 10 cases of diaphragmatic hernia following 876 cases of resection for esophageal and cardiac carcinoma since 1988 was performed.Results:The incidence in this series was 1.14%. Among the 3 early cases which occurred within 5 days after operation,only one case had suggestive symptom,on the contrary,among the rest 7 cases,5 had diagnostic symptoms;There were 3 cases of strangulated hernia and 4 cases of sliding hernia in this group.10 cases was diagnosed through chest film or bedside chest film.10 cases received hernioplasty,9 cases through thoracic approach,one case through abdominal approach,9 cases achieved satisfying results, one case died of postoperative complications.Conclusion:Diaphragmatic hernia following resection for esophageal and cardiac carcinoma is a rare complication,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.