Herbella F A M, Regatieri C V S, Moreno D G, Matone J, Del Grande J C
Department of Surgery, Esophagus Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP Brazil.
Dis Esophagus. 2006;19(5):406-9. doi: 10.1111/j.1442-2050.2006.00595.x.
Esophagectomy is associated with a significant number of complications, some of them related to the concomitant vagotomy. The vagal-sparing esophagectomy is an attractive alternative to the conventional procedure; however, few clinical series have attested the integrity of the vagi nerves after esophagectomy. The surgical anatomy of the vagus in the mediastinum has received little interest as well. The anatomy of the vagus was studied in 30 fresh cadavers. Twenty cadavers were submitted to a vagal-sparing esophagectomy, and after the procedure, anatomical vagal integrity was evaluated. Concerning the anatomy of the vagus, one or more vagal trunks were present in all cases. Four patterns were identified: Type I, two distinct trunks without communicating branches, present in eight (26.7%) cases; Type II, two distinct trunks with communicating branches, present in 17 (56.7%) cases; Type III, one or more bifurcated trunks, present in four (13.3%) cases; and Type IV, crossing trunks, present in one (3.3%) case. Regarding the esophagectomy, operative accidents were not noticed; in five cases, there was incomplete removal of the muscular layer of the esophagus. In all cases vagi nerves were preserved. The vagus is preserved in a cadaveric model of the vagal sparing esophagectomy, irrespective of the anatomy of the vagus in the mediastinum.
食管切除术会引发大量并发症，其中一些与同期迷走神经切断术有关。保留迷走神经的食管切除术是传统手术的一种有吸引力的替代方法；然而，很少有临床系列证实食管切除术后迷走神经的完整性。纵隔内迷走神经的手术解剖学也很少受到关注。对30具新鲜尸体的迷走神经进行了解剖研究。20具尸体接受了保留迷走神经的食管切除术，术后对迷走神经的解剖完整性进行了评估。关于迷走神经的解剖结构，所有病例中均存在一条或多条迷走神经干。识别出四种类型：I型，两条不同的神经干且无交通支，见于8例（26.7%）；II型，两条不同的神经干且有交通支，见于17例（56.7%）；III型，一条或多条分叉神经干，见于4例（13.3%）；IV型，交叉神经干，见于1例（3.3%）。关于食管切除术，未发现手术意外；5例中食管肌层切除不完全。所有病例中迷走神经均得以保留。在保留迷走神经的食管切除尸体模型中，无论纵隔内迷走神经的解剖结构如何，迷走神经均可保留。
