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KMID : 0364019760090020298
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Korean Journal of Thoracic and Cardiovascular Surgery
1976 Volume.9 No. 2 p.298 ~ p.310
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Surgical Management of the Benign Esophageal Diseases
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朴胄澈/Park, Joo Chul
盧浚亮/金鍾煥/徐景弼/李寧均/Rho, Joon Ryang/Kim, Chong Whan/Suh, Kyung Phil/Lee, Yung-Kyoon
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Abstract
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A clinical analysis was performed on 118 cases of the benign esophageal diseases experienced at Department of Thoracic Surgery, Seoul National University Hospital during 20 year period from 1957 to 1976.
Of 118 cases of the benign esophageal diseases, there were 84 patients of esophagenal stenosis, 14 of esophageal perforation, 8 of esophageal atresia, 7 of achalasia, 2 of hiatal hernia, 2 of esophageal foreign body and one of esophageal diverticulum.
Fifty-one patients were male and sixty-seven were female, and ages ranged from one day to sixty-four years with peak incidence in the age group of 20 to 29 years.
All but one of the esophageal stenosis were caused by corrosive esophagitis and ages ranged from three to sixty-four years with peak incidence in third decade. Main symptoms of the esophageal stenosis were dysphagia, weight loss and chest pain in order and mostly began between one month and one year after ingestion of corrosive agents. Corrosive esophageal stenosis developed most frequently in middle one-third of the esophagus and about one-forth of them were diffuse.
Operations were performed on 72 patients of esophageal stenosis of whom 26 patients had esophagocOlogastrostomy, 21 gastrostomy, 20 esophagogastrostomy, 4 esophagojejunogastrostomy and 2 pharyngogastrostomy. There were 5 deaths in the postoperative period, an operative mortality of 6.9 percent, and 20 patients had one or two complications: eight were anastomotic leaks, 6 gangrenes of replaced loop, 4 wound abscesses and others.
The causes of the esophageal perforation were traumatic in 7 cases, caustics in 4 and spontaneous in 3, and the most frequent site of the perforation was lower one-third of the esophagus. Frequent symptoms of the esophageal perforation were pain, fever, dysphagia and dyspnea, and preoperatively there were mediastinitis in 8 cases, empyema in 7, lung abscess in 3 and others.
All 14 patients of the esophageal perforation underwent operation: primary closure in 7 cases, drainage in 4, esophagogastrostomy in 2 and esophageal diversion in one. There were 4 postoperative deaths and 11 postoperative complications occured in 7 patients.
The duratibn of symptoms in achalasia was between .3 months and 25 years with..an average duration of 6.2 years. Frequent symptoms of the achlasia esophagi were dysphagia regurgitation,
J, pain and weight loss in order. All 7-patients of achlasia underwent modified Heller´g` operatian where 2 patients had complications, restenosis in one and esophageal perforation .in _ another. ´
All 8 patients of congenital esophageal atresia had distal tracheoesophageal fistula and--were admitted within 5 days of life, but there were pneumonic consolidation on chest `;-ray in 5 patients. Five patients underwent one staged operation with the result of 2 deaths and one anastomotic leak.
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KEYWORD
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