Ataka Ryo, Tsunoda Shigeru, Goto Saori, Nishigori Tatsuto, Hisamori Shigeo, Obama Kazutaka, Sakai Yoshiharu
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Surg Case Rep. 2020 Feb 26;6(1):43. doi: 10.1186/s40792-020-00805-0.
Killian-Jamieson diverticulum is a rare pharyngoesophageal diverticulum. The risk of intraoperative injury of the recurrent laryngeal nerve (RLN) is high during surgical resection of Killian-Jamieson diverticulum because the RLN usually runs next to the base of the diverticulum. We present a case of Killian-Jamieson diverticulum that was safely resected with effective use of an intraoperative nerve monitoring (IONM) system with a handheld stimulating probe to prevent RLN injury.
A 69-year-old man complaining of dysphagia was diagnosed with Killian-Jamieson diverticulum and underwent open transcervical diverticulectomy. Because the anterior aspect of the diverticulum was expected to be close to the RLN, the accurate location of the RLN was checked during dissection by intermittent stimulation using a handheld probe of the IONM system to avoid mechanical and thermal injury. The diverticulum was transected longitudinally using a linear stapler, and the staple line was buried using absorbable sutures from the distal end. During its closure, RLN was identified very close to the diverticulum stump by IONM, and the upper side of the stump was left unburied to avoid RLN injury. The postoperative course was uneventful and the patient was discharged on postoperative day 7. Postoperative evaluation showed no vocal cord paralysis.
IONM may be beneficial during open surgery for Killian-Jamieson diverticulum, which usually protrudes just lateral to the RLN.
基利安 - 贾米森憩室是一种罕见的咽食管憩室。在基利安 - 贾米森憩室手术切除过程中，喉返神经（RLN）术中损伤风险较高，因为喉返神经通常紧邻憩室底部走行。我们报告一例基利安 - 贾米森憩室病例，通过有效使用带有手持刺激探头的术中神经监测（IONM）系统安全切除憩室，以预防喉返神经损伤。
一名69岁男性，因吞咽困难就诊，被诊断为基利安 - 贾米森憩室，并接受了开放性经颈憩室切除术。由于预计憩室前侧靠近喉返神经，在解剖过程中使用IONM系统的手持探头进行间歇性刺激，以检查喉返神经的准确位置，避免机械和热损伤。使用线性吻合器纵向横断憩室，并用可吸收缝线从远端埋入吻合线。在关闭过程中，通过IONM发现喉返神经非常靠近憩室残端，残端上侧未进行埋入以避免喉返神经损伤。术后病程顺利，患者于术后第7天出院。术后评估显示无声带麻痹。
对于通常突出于喉返神经外侧的基利安 - 贾米森憩室，术中神经监测在开放手术中可能有益。
