Tokic Tomislav, Kirac Iva, Hrabar Davor, Troskot Branko, Bekavac-Beslin Miroslav
University of Zagreb, School of Medicine, 10000 Zagreb, Croatia.
Department of Surgical Oncology, University Hospital for Tumors, University Hospital Center 'Sestre Milosrdnice', 10000 Zagreb, Croatia.
J Surg Case Rep. 2018 Apr 9;2018(4):rjy066. doi: 10.1093/jscr/rjy066. eCollection 2018 Apr.
This is a description of transhiatal laparoscopic approach for mid-esophageal diverticulum. Traditionally mid-esophageal diverticula are approached by thoracotomy or thoracoscopy, with the laparoscopic technique being reserved for epiphrenic diverticula. A 78-year-old Caucasian female with a secondary dilatative ischemic cardiomyopathy presented with dysphagia, tenderness in the epigastrium and a considerable weight loss. A large mid-esophageal diverticulum was found on barium swallow and confirmed by CT scan. Underlying achalasia was recorded on manometry. The patient underwent diverticulectomy via transhiatal approach, followed by Heller myotomy and Dor fundoplication. Throughout the procedure auxiliary, esophagoscopic image was provided by interventional gastroenterologist due to a very narrow operating field and lack of orientation points. Based on our experience with this case, we propose transhiatal approach as a feasible alternative to thoracoscopy, in particular with patients who suffer from cardiac or pulmonary co-morbidities which make traditional techniques of high risk.
这是一篇关于经裂孔腹腔镜治疗食管中段憩室的描述。传统上，食管中段憩室通过开胸手术或胸腔镜手术治疗，腹腔镜技术则用于治疗膈上憩室。一名78岁患有继发性扩张型缺血性心肌病的白人女性，出现吞咽困难、上腹部压痛及体重显著减轻。吞钡检查发现一个大的食管中段憩室，CT扫描予以证实。食管测压记录显示存在潜在的贲门失弛缓症。患者通过经裂孔途径接受憩室切除术，随后进行Heller肌切开术和Dor胃底折叠术。在整个手术过程中，由于手术视野非常狭窄且缺乏定位点，介入胃肠病学家提供了辅助食管镜图像。基于我们对该病例的经验，我们建议经裂孔途径作为胸腔镜手术的一种可行替代方法，特别是对于患有心脏或肺部合并症而使传统技术具有高风险的患者。
