Junlapan Attapon, Abu-Ghanem Sara, Sung C Kwang, Damrose Edward J
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Eur Arch Otorhinolaryngol. 2019 May;276(5):1423-1429. doi: 10.1007/s00405-019-05374-z. Epub 2019 Mar 15.
Transoral resection of Zenker's diverticulum (TORD) was first reported in 2010. We present results for our modified approach to transoral resection (MTORD)-full-thickness cricopharyngeal myectomy, diverticulum sac excision, and suture closure of the pharyngotomy-and evaluate its safety and efficacy compared to endoscopic stapling and open approaches.
A retrospective study was performed in patients who underwent transoral resection of Zenker's diverticulum using MTORD, endoscopic stapler-assisted diverticulotomy (ESD), or trancervical diverticulectomy (TCD) from July 2009 to August 2017. Pre-operative evaluation included barium swallow and subjective characterization of swallowing dysfunction using the EAT-10 and Reflux Symptom Index (RSI). Complications, length of hospitalization, recurrence, and revision rates were also evaluated.
Of 92 patients reviewed, 18 underwent MTORD, 45 underwent ESD and 29 underwent TCD. Major complications were only observed in ESD and TCD. Recurrence which required revision surgery was only observed in ESD. EAT-10 and RSI scores significantly improved and RSI scores normalized post-operatively for all approaches in short-term (< 1 year) follow-up.
MTORD is a safe and effective option for complete Zenker's diverticulectomy. Complication rates are low. To date, no patient has required reoperation, although more cases and longer term follow-up are needed for more complete comparison to ESD and traditional open excision.
经口切除Zenker憩室（TORD）于2010年首次报道。我们展示了改良经口切除方法（MTORD）——环状咽肌全层切除术、憩室囊切除术及咽切开术缝合关闭——的结果，并与内镜吻合器和开放手术方法相比，评估其安全性和有效性。
对2009年7月至2017年8月间接受MTORD、内镜吻合器辅助憩室切开术（ESD）或经颈憩室切除术（TCD）经口切除Zenker憩室的患者进行回顾性研究。术前评估包括吞钡检查以及使用EAT-10和反流症状指数（RSI）对吞咽功能障碍进行主观特征描述。还评估了并发症、住院时间、复发率和翻修率。
在92例接受评估的患者中，18例接受MTORD，45例接受ESD，29例接受TCD。主要并发症仅在ESD和TCD中观察到。需要翻修手术的复发仅在ESD中观察到。在短期（<1年）随访中，所有手术方法的EAT-10和RSI评分均显著改善，术后RSI评分恢复正常。
MTORD是完全切除Zenker憩室的一种安全有效的选择。并发症发生率低。迄今为止，尚无患者需要再次手术，不过与ESD和传统开放切除术进行更全面比较还需要更多病例和更长时间的随访。
