Teus J Weijs, Jelle P Ruurda, Richard van Hillegersberg, Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
World J Gastroenterol. 2013 Oct 21;19(39):6509-14. doi: 10.3748/wjg.v19.i39.6509.
Esophagectomy, the surgical removal of all or part of the esophagus, is a surgical procedure that is associated with high morbidity and mortality. Pulmonary complications are an especially important postoperative problem. Therefore, many perioperative strategies to prevent pulmonary complications after esophagectomy have been investigated and introduced in daily clinical practice. Here, we review these strategies, including improvement of patient performance and technical advances such as minimally invasive surgery that have been implemented in recent years. Furthermore, interventions such as methylprednisolone, neutrophil elastase inhibitor and epidural analgesia, which have been shown to reduce pulmonary complications, are discussed. Benefits of the commonly applied routine nasogastric decompression, delay of oral intake and prophylactic mechanical ventilation are unclear, and many of these strategies are also evaluated here. Finally, we will discuss recent insights and new developments aimed to improve pulmonary outcomes after esophagectomy.
食管切除术，即全部或部分食管的外科切除手术，是一种与高发病率和死亡率相关的外科手术。肺部并发症是术后一个特别重要的问题。因此，许多针对预防食管切除术后肺部并发症的围手术期策略已经被研究并在日常临床实践中得到应用。在这里，我们将对这些策略进行综述，包括近年来实施的改善患者状况的策略和微创手术等技术进步。此外，我们还将讨论已经证明可以减少肺部并发症的干预措施，如甲基强的松龙、中性粒细胞弹性蛋白酶抑制剂和硬膜外镇痛。常规应用的鼻胃管减压、延迟经口进食和预防性机械通气的益处并不明确，我们也将在这里对这些策略进行评估。最后，我们将讨论旨在改善食管切除术后肺部转归的最新研究进展。
