식도 재건 수술후 발생한 합병증 치험

Treatment of the complications of the esophageal reconstructive procedures

Post-anastomotic leakage and stenoses remain major complications and are still responsible for many mortalities after esophageal reconstructive procedures. If the hand-suture is used, anastomotic leaks developed frequently than stenoses. But post-anastomotic leakages are more critical than post-anastomotic stenoses. If the stapler is used, anastomotic stenoses will develop frequently and not critical than anastomotic leakages. The stapler suture method is easier and quicker than the hand suture method in the esophageal anastomotic procedures. But the disadvantages of the stapler suture method is that there is not reachable site with anastomotic stapler the thoracic inlet region and the cost is expensive. We have treated 44 cases of the surgical complications after esophageal reconstructive procedure with conservative and surgical treatment for 10 years from January, 1980 to December, 1989. The anastomotic site stenoses were 8 cases in the hand-suture methods and 4 cases in the stapler-suture methods. The anastomotic leaks were 8 cases in hand-suture methods and 5 cases in stapler-suture methods. There were one death in the surgical repair of four post-operative anastomotic stenoses and two deaths in the surgical repair of three post-operative anastomotic leakages. Ever though we consider that there is more anastomotic leakage than stenoses after the hand-suture methods in esophageal reconstructive procedures. the cost with long stay in the intensive care unit to treat anastomotic leakage after the hand-suture, would be more expensive than-the cost of the treatment of the anastomotic stenoses after auto-suture.