Koch M, Thimsen V, Traxdorf M, Zenk J, Iro H, Treutlein E, Mantsopoulos K
Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
Eur Rev Med Pharmacol Sci. 2021 Jul;25(14):4791-4798. doi: 10.26355/eurrev_202107_26392.
Very few reports investigated techniques of closure of the basal wound area to reduce severe complications like mediastinitis after endoscopic laser diverticulotomy. In this study, we report our experiences after routine use of a collagen-fibrin sealant patch for basal wound covering after laser diverticulotomy in consideration of postoperative complications and recurrence rates.
This retrospective study was conducted in a tertiary referral center and university hospital. Endoscopic laser diverticulotomies performed in our hospital between January 2006 and July 2018 were included. After complete transection of the laser septum of the diverticulum, we placed a collagen-fibrin patch onto the basal wound area to cover the opening to the mediastinum. Patient records were evaluated to assess the occurrence of perioperative complications, and the data were compared with those reported in the literature.
A total of 127 endoscopic laser diverticulotomies were performed in 109 patients (71 men, 38 women) suffering from Zenker's diverticulum. Morality rate was 0%, in particular no mediastinitis was observed. Mediastinal emphysema was observed in two patients (1.6%), and temporary or persistent recurrent nerve palsy in one patient (0.8%) each. The mean follow-up period was 71.6±5.16 months. Recurrent symptomatic diverticulum was observed in 19.3% of the patients.
These findings suggest that use of a collagen-fibrin sealant patch in endoscopic laser diverticulotomy may contribute to the safety of endoscopic controlled laser diverticulotomy without comprising the success rates.
很少有报告研究封闭基底伤口区域的技术，以减少内镜激光憩室切开术后纵隔炎等严重并发症。在本研究中，考虑到术后并发症和复发率，我们报告了在激光憩室切开术后常规使用胶原纤维蛋白封闭剂贴片覆盖基底伤口的经验。
本回顾性研究在一家三级转诊中心和大学医院进行。纳入2006年1月至2018年7月在我院进行的内镜激光憩室切开术。在完全切断憩室的激光隔膜后，我们将胶原纤维蛋白贴片放置在基底伤口区域，以覆盖通向纵隔的开口。评估患者记录以评估围手术期并发症的发生情况，并将数据与文献报道的数据进行比较。
109例患有Zenker憩室的患者（71例男性，38例女性）共进行了127例内镜激光憩室切开术。死亡率为0%，尤其未观察到纵隔炎。2例患者（1.6%）出现纵隔气肿，各有1例患者（0.8%）出现暂时性或持续性喉返神经麻痹。平均随访期为71.6±5.16个月。19.3%的患者出现复发性有症状憩室。
这些发现表明，在内镜激光憩室切开术中使用胶原纤维蛋白封闭剂贴片可能有助于内镜控制激光憩室切开术的安全性，而不影响成功率。
