食管切除术是食管癌治疗的重要基石。Ivor-Lewis食管切除术的术后喂养选择包括鼻空肠管(NJT),饲喂空肠造口术,和直接口服喂养。NJT传统上放置在内窥镜或透视引导下。在本例报告中,我们提出了一种用于NJT放置的替代技术。一名55岁的男性出现吞咽困难到我们的诊所就诊。在食管胃十二指肠镜检查中,观察到胃食管交界处(GOJ)肿瘤.活检诊断为中分化腺癌。患者接受了8个周期的表柔比星,顺铂,和卡培他滨(ECX),随后进行了Ivor-Lewis食管切除术。此病例报告重点介绍了在不使用内窥镜检查或透视指导的情况下,在接受Ivor-Lewis食管切除术的患者中放置NJT的技术方面和潜在陷阱。Ivor-Lewis食管切除术后直接经口喂养可能导致热量供应欠佳,而空肠造口术与皮炎等并发症相关。伤口感染,和肠梗阻。另一方面,内窥镜或荧光镜插入NJT会使吻合口暴露于潜在有害的机械力。使用我们的技术可以轻松地将NJT放置在接受混合Ivor-Lewis食管切除术的患者中。该技术的安全性可以通过进一步的研究来研究。
Esophagectomy is an important cornerstone in the management of esophageal cancer. Post-operative feeding options in Ivor-Lewis esophagectomy include nasojejunal tube (NJT), feeding jejunostomy, and direct oral feeding. NJT is traditionally placed endoscopically or under fluoroscopic guidance. In this
case report we present an alternate technique for NJT placement. A 55-year-old male presented to our clinic with dysphagia. On esophagogastroduodenoscopy, a gastroesophageal junction (GOJ) tumor was noted. A diagnosis of moderately differentiated adenocarcinoma was made on biopsy. The patient received eight cycles of epirubicin, cisplatin, and capecitabine (ECX), following which an Ivor-Lewis esophagectomy was carried out. This
case report highlights the technical aspects and potential pitfalls of placing NJT in patients undergoing Ivor-Lewis esophagectomy without the use of endoscopy or fluoroscopic guidance. Direct oral feeding after Ivor-Lewis esophagectomy may lead to suboptimal caloric provision while feeding jejunostomy is associated with complications such as dermatitis, wound infection, and intestinal obstruction. On the other hand, endoscopic or fluoroscopic insertion of NJT can expose the anastomosis to potentially harmful mechanical forces. NJT can be easily placed using our technique in patients undergoing hybrid Ivor-Lewis esophagectomy. The safety of this technique can be investigated by further studies.