Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Experience with a Safe Anastomotic Method for Ivor Lewis Operation

Ivor Lewis 수술 후 발생되는 문합 부위 합병증을 예방하기 위한 술식 평가

  • Kim, Jeong-Won (Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Lee, Yong-Jik (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chang, Yong-Jin (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Chang-Ryul (Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jung, Jong-Pil (Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 김정원 (울산대학교 의과대학 울산대학교병원 흉부외과학교실) ;
  • 이용직 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 장용진 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 박창률 (울산대학교 의과대학 울산대학교병원 흉부외과학교실) ;
  • 정종필 (울산대학교 의과대학 울산대학교병원 흉부외과학교실)
  • Published : 2008.10.05
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Abstract

Background: When it comes to esophageal cancer operations, the prevalence of anastomotic complications that adversely affect quality of life is related to the type of anastomotic procedure and the operative site. We studied outcomes related to a safe anastomotic method used in Ivor Lewis esophagogastrectomy for preventing anastomotic leakage and stricture formation. Material and Method: Between May 2003 and April 2007, 18 patients with esophageal cancer underwent this type of esophagogastrectomy. Four people were lost to follow-up. There were 17 men (94.4%) and 1 woman. The mean patient age was 61 years (range, $46{\sim}73$ years). Result: The mean follow-up period was 17.2 months (range, $1{\sim}45$ months). There was no anastomotic leakage. There was one benign anastomotic stricture (5.6%) requiring esophageal balloon dilatation, which was accomplished with a 25 mm circular stapler. Conclusion: We experienced relatively good postoperative results using a safe anastomotic method in the Ivor lewis operation for preventing anastomotic complications. These results suggest that this anastomotic method is effective in reducing the incidence of benign anastomotic complications.

배경: 식도암 수술에서 문합 부위 합병증은 수술 방법, 문합 위치 등과 관계 있다고 알려져 있으며 수술 후 환자의 삶의 질에도 중요한 부문을 차지한다. 저자들은 식도암 수술에 대한 고전적인 Ivor Lewis수술 중 stapling후 문합부의 조직 긴장 장력을 감소시킴으로써 식도-위 문합 부위 합병증의 발생 빈도를 줄이도록 고안된 술식을 평가하고자 하였다. 대상 및 방법: 2003년 5월부터 2007년 4월까지 식도암으로 Ivor Lewis 수술을 시행 받은 22명 중 외래 추적관찰이 가능한 18명을 대상으로 하였다 평균 연령은 61세$(46{\sim}73)$이었고 남자가 17명(94.4%)이었다. 양성 문합 협착은 술 후 추적 관찰 중 연하곤란을 호소하는 환자들에게 식도조영술을 시행하여 식도내 풍선화장술이 필요한 경우로 정의하였다. 결과: 평균 추적관찰 기간은 17.2개월$(1{\sim}45)$이었다. 수술 후 문합 부위 누출은 없었다. 양성 문합 협착은 1명(5.6%1에서 수술 후 4개월째 발생하였으며 수술 당시 식도 내경이 작아서 25 mm Stapler로 문합했었다. 식도내 풍선확장술을 2차례 시행한 후 증상이 호전되었으며 현재까지 38개월째 외래 추적 관찰 중이다. 결론: Ivor Lewis 수술 후 발생하는 양성 문합 협착 등 합병증을 줄이기 위하여 고안된 본원의 문합 술식은, 다른 저자들과 비교하여 효과적인 방법으로 생각되며 이후 장기적인 연구가 필요할 것으로 생각된다.

Keywords

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