Tabatabaei Seyed Abbas, Hashemi Seyed Mozafar, Kelidari Behrooz
Department of surgery, Isfahan University of Medical Science (IUMS), Isfahan, Iran.
Iran J Cancer Prev. 2015 Mar-Apr;8(2):89-93.
Considering the poor survival rate of patients with esophageal cancers, mainly due to the disease effects and surgical co morbidities, we have aimed to introduce a new method of Transhiatal Esophagectomy (THE) without mediastinal manipulation for lower third esophageal and cardial cancers. It has suggested that using this technique would decrease mentioned complications.
In this prospective study, patients with esophageal cancer who referred for surgical treatment have enrolled and undergone to new method of THE, without mediastinal manipulation. Pre and post-operative morbidities as well as the duration of procedure, duration of hospital and ICU stay have recorded. All patients have followed up or 4-40 months.
In this study 53 patients with mean age of 55.2+/-10.3 years have undergone esophagectomy, and then in 50 of them the new method has performed. Median operative time and volume of blood loss was 120 minutes and 130 ml, respectively. Median duration of hospital and ICU stay was 7 and 1 day, respectively. There were no Pre-operative mortalities, arrhythmia, hemodynamic instability and mediastinal vessels injury. The most common co morbidities have related to our new method were mediastinal pleura injury, anastomotic leaks and anastomotic narrowing with 20%, 16% and 10% reported rate, respectively.
The findings of current study have indicated that transhiatal esophagectomy without mediastinal manipulation, has represented a safe and effective method for treatment of lower third esophageal and cardial cancers due to its potential advantages of decreased blood loss, being a less traumatic procedure, minimal cardiopulmonary complications and low rate of hospital mortality.
鉴于食管癌患者的生存率较低，主要是由于疾病影响和手术合并症，我们旨在引入一种新的经裂孔食管切除术（THE）方法，用于治疗食管下段和贲门癌，且不进行纵隔操作。有研究表明，使用该技术可减少上述并发症。
在这项前瞻性研究中，纳入了因手术治疗前来就诊的食管癌患者，并对其采用了不进行纵隔操作的新THE方法。记录了术前和术后的合并症、手术时间、住院时间和重症监护病房（ICU）停留时间。所有患者均进行了4至40个月的随访。
本研究中，53例平均年龄为55.2±10.3岁的患者接受了食管切除术，其中50例采用了新方法。中位手术时间和失血量分别为120分钟和130毫升。中位住院时间和ICU停留时间分别为7天和1天。术前无死亡、心律失常、血流动力学不稳定和纵隔血管损伤。与我们的新方法相关的最常见合并症分别为纵隔胸膜损伤、吻合口漏和吻合口狭窄，报告发生率分别为20%、16%和10%。
本研究结果表明，不进行纵隔操作的经裂孔食管切除术，因其具有减少失血、创伤较小、心肺并发症极少和医院死亡率低等潜在优势，是治疗食管下段和贲门癌的一种安全有效的方法。
