Tharavej Chadin, Navicharern Patpong, Udomsawaengsup Suthep, Pungpapong Suppa-art
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2010 Sep;93(9):1103-6.
The authors reported the feasibility and safety of thoracoscopic approach for resection of the esophagus in two patients with diffuse corrosive esophageal stricture.
The unrelenting corrosive strictures of esophagus merit esophageal substitution. Because of the risk of complications in the retained esophagus, such as malignancy, mucocele, gastroesophageal reflux, and bleeding, esophageal resection is deemed necessary. Transthoracic approach for esophageal resection is considered safe but requiring thoracotomy. Transhiatal resection of a scared esophagus could be associated with serious complications. Less was known regarding the safety and feasibility of thoracoscopic resection of the esophagus in corrosive stricture of the esophagus.
Thoracoscopic approach was used for mobilization of the scarred esophagus in two female patients. Laparotomy with colonic mobilization was performed in the second phase of the operation. Pharyngocolonic and esophagocolonic anastomosis were done via left neck incision in each patient. Intra-operative and post-operative complications were observed. Swallowing ability was assessed in the early postoperative period.
Thoracoscopic esophageal mobilization was successfully performed without complications. Any adhesions around the esophagus could be clearly seen and divided using harmonic scalpel under direct vision. Operative duration of the thoracoscopic part was 104 and 120 minutes and total blood loss was 320 and 350 ml respectively. Postoperative period was uneventful. The patient could have regular diet on day 8 and 9 after surgery.
Thoracoscopic approach for esophageal resection could be safely performed for the extirpation of diffuse esophageal stricture. Postoperative complication is being assessed in the authors' prospective trial.
作者报告了胸腔镜手术切除两名弥漫性腐蚀性食管狭窄患者食管的可行性和安全性。
食管的顽固性腐蚀性狭窄值得进行食管替代。由于保留食管存在发生并发症的风险，如恶性肿瘤、黏液囊肿、胃食管反流和出血，因此认为有必要进行食管切除术。经胸食管切除术被认为是安全的，但需要开胸手术。经裂孔切除瘢痕食管可能会引发严重并发症。关于胸腔镜切除腐蚀性食管狭窄患者食管的安全性和可行性，人们了解较少。
在两名女性患者中采用胸腔镜手术游离瘢痕食管。手术的第二阶段进行剖腹结肠游离术。每位患者均通过左颈部切口进行咽结肠和食管结肠吻合术。观察术中及术后并发症。在术后早期评估吞咽能力。
胸腔镜食管游离术成功完成，无并发症发生。食管周围的任何粘连都能在直视下清晰看到，并用超声刀分离。胸腔镜部分的手术时间分别为104分钟和120分钟，总失血量分别为320毫升和350毫升。术后情况平稳。患者在术后第8天和第9天能够正常饮食。
胸腔镜手术切除食管可安全地用于切除弥漫性食管狭窄。作者正在进行的前瞻性试验中对术后并发症进行评估。
