Hoffmann M, Fazel A, Mews K-G, Ambrosch P
Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany.
Clin Otolaryngol. 2017 Jun;42(3):592-596. doi: 10.1111/coa.12777. Epub 2016 Nov 9.
To underline the value of the microendoscopic CO -LASER-assisted treatment (MEDCO ) for Zenker's diverticulum by investigating a large patient cohort treated in a single medical centre.
Retrospective cohort study of consecutive patients.
Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University Kiel, Germany.
A total of 227 patients with Zenker's diverticulum were treated by MEDCO , and the results were compared with those reported in the literature for the open transcervical approach (OTA) and the endoscopic staple-assisted oesophagodiverticulostomy (ESED).
Data assessment regarding preoperative symptoms, perioperative management, morbidity, mortality and longtime results. Comparison of results with data from the literature regarding MEDCO , ESED and OTA.
Operation duration: 25 min median; morbidity: 4.7%; mortality: 0%; mediastinitis: 0.9%; hospitalisation: 7 days; feeding tube dependency: 4 days; recurrence rate: 6.1%. Rise of body temperature above 38°C and 39°C in 36.7% and 12.2% of cases on first postoperative day, respectively.
The results identify MEDCO as superior in comparison with ESED and OTA concerning the treatment for Zenker's diverticulum especially in terms of excellent long-term functional results and a low morbidity and mortality. The short operation time qualifies MEDCO as specifically suitable for the treatment of the characteristic patient cohort with Zenker's diverticulum, namely the elderly, whereas OTA should be reserved for cases with sophisticated or impossible endoscopic exposure of the pouch. The occurrence of perioperative fever can be managed with a systemic antibiotic and antipyretic medication. Although a mediastinitis as major complication is a rare event, the early introduction of its diagnosis with CT scans and consecutive therapy including thoracotomies can be lifesaving.
通过对在单一医疗中心接受治疗的大量患者队列进行研究，强调微内镜二氧化碳激光辅助治疗（MEDCO）对Zenker憩室的价值。
对连续患者进行回顾性队列研究。
德国基尔基督教-阿尔布雷希特大学耳鼻咽喉头颈外科。
共有227例Zenker憩室患者接受了MEDCO治疗，并将结果与文献中报道的开放经颈入路（OTA）和内镜吻合器辅助食管憩室造口术（ESED）的结果进行比较。
关于术前症状、围手术期管理、发病率、死亡率和长期结果的数据评估。将结果与文献中关于MEDCO、ESED和OTA的数据进行比较。
手术时间：中位数25分钟；发病率：4.7%；死亡率：0%；纵隔炎：0.9%；住院时间：7天；依赖饲管时间：4天；复发率：6.1%。术后第一天分别有36.7%和12.2%的病例体温升高超过38°C和39°C。
结果表明，在治疗Zenker憩室方面，MEDCO与ESED和OTA相比更具优势，特别是在长期功能结果优异以及低发病率和死亡率方面。短手术时间使MEDCO特别适合治疗Zenker憩室的特定患者群体，即老年人，而OTA应保留用于袋囊内镜暴露复杂或无法进行内镜暴露的病例。围手术期发热可通过全身使用抗生素和解热药物进行处理。虽然纵隔炎作为主要并发症是罕见事件，但早期通过CT扫描进行诊断并进行包括开胸手术在内的后续治疗可能挽救生命。
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