Cury E K, Schraibman V, De Vasconcelos Macedo A L, Echenique L S
Hospital Israelita Albert Einstein and the Division of Pediatric Surgery, Department of Surgery, Federal University of São Paulo, São Paulo, Brazil.
J Pediatr Surg. 2001 Sep;36(9):E17. doi: 10.1053/jpsu.2001.26399.
Minimal access surgery is an alternative to open surgery in esophageal resections. Thoracoscopic surgery has been utilized for both benign and malignant esophageal lesions and is a complex and challenging surgical procedure that can provide some benefits in comparison with open thoracotomy. Many studies have described laparoscopic or thoracoscopic-assisted esophagectomy in adults. So far, to the best of our knowledge, there is no study about thoracoscopic esophagectomy in children. This report describes 2 pediatric cases of benign esophageal lesions: one stricture after accidental ingestion of caustic soda and one esophageal stenosis after thyroglossal duct complication. Both patients were submitted to thoracoscopic esophagectomy combined with laparotomy and open cervical exploration with success. This procedure presents some potential advantages when compared with open esophagectomy: shorter hospital stay, precise dissection of mediastinal structures, less postoperative pain, less blood loss during surgery and less long-term discomfort. In our cases, thoracoscopic surgery for children showed the same benefits as in adults. Although very feasible, it should not be attempted without sufficient training and should be carried out only in specialized medical centers and by surgeons with adequate experience with open esophagectomy.
微创手术是食管切除术的一种替代开放手术的方法。胸腔镜手术已被用于治疗良性和恶性食管病变，是一种复杂且具有挑战性的手术操作，与开胸手术相比有一些优势。许多研究描述了成人的腹腔镜或胸腔镜辅助食管切除术。据我们所知，目前尚无关于儿童胸腔镜食管切除术的研究。本报告描述了2例小儿良性食管病变病例：1例因意外摄入苛性钠后出现狭窄，1例因甲状舌管并发症后出现食管狭窄。两名患者均接受了胸腔镜食管切除术联合剖腹术及开放颈部探查，手术成功。与开放食管切除术相比，该手术具有一些潜在优势：住院时间缩短、纵隔结构解剖精确、术后疼痛减轻、手术中失血较少以及长期不适较少。在我们的病例中，儿童胸腔镜手术显示出与成人相同的优势。尽管非常可行，但如果没有足够的培训则不应尝试，并且应仅在专业医疗中心由有足够开放食管切除术经验的外科医生进行。
