电视胸腔镜入路治疗晚期胸段食管穿孔，无需缝合。
Video-thoracoscopic approach, without suture, of late thoracic esophageal perforations.
作者信息
Abou-Mourad Omar Moté, Andrade Filipe Moreira de, Júdice Luiz Felippe, Júdice Ângelo, Carvalho Antonio Bento Costa Borges, Morard Maria Ribeiro Santos, Fiorelli Rossano Kepler Alvim
机构信息
Universidade Federal Fluminense, Departamento de Cirurgia, Divisão de Cirurgia Torácica, Niterói, RJ, Brasil.
Universidade Severino Sombra, Departamento de Cirurgia, Vassouras, RJ, Brasil.
出版信息
Rev Col Bras Cir. 2017 Jul-Aug;44(4):354-359. doi: 10.1590/0100-69912017004009.
OBJECTIVES
to evaluate the use of video-thoracoscopy, in the treatment of late perforations of the thoracic esophagus, without suture or organ resection.
METHODS
retrospective analysis of patients with late diagnosis (> 12 hours) of thoracic esophageal perforation treated by video-thoracoscopy, without suture or organ resection, over a 15-year period.
RESULTS
sixteen patients were operated on, ten men and six women, aged between 48 and 66 years, with time between the diagnosis of the perforation and the surgery ranging from 16 to 26 hours. All patients underwent video-thoracoscopy, with pulmonary decortication, pleural loculations approach, opening of the mediastinal pleura near the perforation site and debridement of the devitalized tissues, followed by double drainage of the pleural cavity. No esophageal suture or resection was performed, and the patients evolved with complete closure of the lesions, without deaths.
CONCLUSION
the video-thoracoscopic surgical approach was able to control pleural infection, pulmonary expansion and enable complete regeneration of the esophagus with late-diagnosed perforation.
目的
评估电视胸腔镜在治疗晚期胸段食管穿孔时不进行缝合或器官切除的应用效果。
方法
回顾性分析15年间接受电视胸腔镜治疗且未进行缝合或器官切除的晚期胸段食管穿孔（诊断时间>12小时）患者。
结果
16例患者接受手术，其中男性10例，女性6例，年龄在48至66岁之间，穿孔诊断至手术的时间为16至26小时。所有患者均接受电视胸腔镜检查，进行了肺剥脱术、胸膜分隔处理、在穿孔部位附近打开纵隔胸膜并清除失活组织，随后进行胸腔双腔引流。未进行食管缝合或切除，患者病情进展，病变完全闭合，无死亡病例。
结论
电视胸腔镜手术方法能够控制胸膜感染、促进肺扩张，并使晚期诊断的食管穿孔实现完全再生。
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