Atkins B Zane, Fortes Daniel L, Watkins Kevin T
Department of Surgery, Wilford Hall USAF Medical Center, San Antonio, Texas 78236-5300, USA.
Dysphagia. 2007 Jan;22(1):49-54. doi: 10.1007/s00455-006-9042-7. Epub 2006 Nov 1.
Minimally invasive (MI) esophageal resection (ER) has the theoretical advantage of reduced postoperative complications compared with standard ER. However, the impact of MIER on rates and severity of pulmonary complications is unclear. Four patients underwent laparoscopic gastroesophageal mobilization and resection followed by gastric pull-up and cervical esophageal anastomosis (MIER). Videofluoroscopic swallowing studies (VFSS) assessed pharyngolaryngeal function postoperatively. All postoperative complications were documented. Each MIER was completed successfully without intraoperative complications. Mean operative time was 4.3 +/- 2 h. Postoperatively, VFSS detected laryngeal penetration, vocal cord paralysis, and/or aspiration in three patients, two of whom experienced severe respiratory complications. MIER patients are susceptible to aspiration, likely due to transient denervation of the pharynx and laryngeal structures. Following MIER, aggressive pulmonary toilet and aspiration precautions are emphasized to reduce pulmonary complications. Furthermore, serial evaluation of deglutition is encouraged to guide the safe and appropriate resumption of oral feeding.
与标准食管切除术相比，微创食管切除术在理论上具有减少术后并发症的优势。然而，微创食管切除术对肺部并发症的发生率和严重程度的影响尚不清楚。4例患者接受了腹腔镜下胃食管游离和切除术，随后进行胃上提和颈段食管吻合术（微创食管切除术）。通过电视荧光吞咽造影检查评估术后咽喉功能。记录所有术后并发症。每例微创食管切除术均成功完成，无术中并发症。平均手术时间为4.3±2小时。术后，电视荧光吞咽造影检查在3例患者中检测到喉穿透、声带麻痹和/或误吸，其中2例出现严重呼吸并发症。微创食管切除术患者易发生误吸，可能是由于咽部和喉部结构的短暂失神经支配。微创食管切除术后，应强调积极的肺部护理和误吸预防措施，以减少肺部并发症。此外，鼓励对吞咽进行连续评估，以指导安全、适当地恢复经口进食。
