Division of Cardiovascular and Thoracic Surgery, Cleveland Clinic, Cleveland, Ohio.
Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
Semin Thorac Cardiovasc Surg. 2021;33(1):242-246. doi: 10.1053/j.semtcvs.2020.08.017. Epub 2020 Aug 25.
Epiphrenic diverticulum is a rare and benign condition with significant surgical morbidity and evolving surgical management. The objective of this study was to analyze short-term clinical outcomes after surgery for epiphrenic diverticula. We conducted a retrospective cohort study in a single tertiary care center of all patients who underwent treatment for epiphrenic esophageal diverticula from June 1990 to December 2016. Data collection included demographics, operative details and short-term outcomes (esophageal leak, other complications, 30-day mortality). In addition, all preoperative imaging was reviewed by an esophageal radiologist in order to describe epiphrenic diverticula characteristics in a uniform and blinded manner. Of the 94 patients in the study, 84 patients were managed with an open surgical approach and 10 with minimally invasive techniques. Median size of diverticula was 5.5 cm and mean height above gastroesophageal junction was 4 cm. A myotomy was completed in 95% of patients and a fundoplication in 58%. The MIS group had a shorter length of stay (4 vs 6 days). Overall complication rate was 27% with an esophageal leak rate of 7% with 60% grade I leaks that sealed with conservative management. Complete resection of the diverticulum, closure of the muscle over the resection, contralateral myotomy, and consideration for partial fundoplication are common strategies utilized to surgically treat patients with epiphrenic diverticulum. Minimally invasive approaches are increasingly utilized.
膈上憩室是一种罕见的良性疾病，具有较高的手术发病率和不断发展的手术治疗方法。本研究的目的是分析膈上憩室手术后的短期临床结果。我们对 1990 年 6 月至 2016 年 12 月期间在一家三级医疗中心接受膈上食管憩室治疗的所有患者进行了回顾性队列研究。数据收集包括人口统计学、手术细节和短期结果（食管漏、其他并发症、30 天死亡率）。此外，所有术前影像学均由食管放射科医生进行评估，以便以统一和盲法的方式描述膈上憩室的特征。在 94 例患者中，84 例采用开放手术治疗，10 例采用微创技术治疗。憩室的中位大小为 5.5cm，距食管胃连接部的平均高度为 4cm。95%的患者完成了肌切开术，58%的患者完成了胃底折叠术。MIS 组的住院时间更短（4 天 vs 6 天）。总体并发症发生率为 27%，食管漏发生率为 7%，60%为 I 级漏，经保守治疗可自行愈合。膈上憩室的常见手术治疗策略包括完全切除憩室、切除处肌肉缝合、对侧肌切开术以及考虑部分胃底折叠术。微创方法的应用越来越广泛。
