Lazim T R, de Castella H C, Browning G
Burton District General Hospital, Burton-on-Trent, Staffordshire, U.K.
Surgery. 1994 Nov;116(5):853-8.
We describe an instrument for mobilizing the normal esophagus without thoracotomy. It is essentially a metal ring introduced through the neck that encircles the esophagus, separating it from surrounding tissues.
Preliminary studies of 12 cadavers were followed by clinical application in 18 patients with esophageal carcinoma and two with benign esophageal lesions.
Pneumothorax occurred in 20%, recurrent laryngeal nerve palsy in 25% (4 of 5 were transient), and thoracotomy for postoperative bleeding from the tumor bed in two cases. No anastomotic leakage occurred. Mortality rate at 30 days after operation was 15%, with an in-hospital mortality rate of 20%. Use of the instrument did not cause any of the described complications. In one patient the esophageal carcinoma was adherent to the trachea, which was injured. No incidence of hypotension or arrhythmia was observed during thoracic esophageal dissection. Blood loss from the mediastinum wa unremarkable. The treatment by stripping is a palliative treatment and precludes a radical curative attempt. The use of this instrument is contraindicated in lesions of the upper and middle parts of the esophagus, and it is not intended to strip a bulky esophagus as in achalasia.
The esophageal dissector made mobilization of the normal thoracic esophagus easier and less time consuming, and yielded no episodes of hypotension or arrythmia.
我们描述了一种无需开胸就能游离正常食管的器械。它本质上是一个通过颈部插入的金属环，环绕食管，使其与周围组织分离。
先对12具尸体进行了初步研究，随后将其应用于18例食管癌患者和2例食管良性病变患者。
气胸发生率为20%，喉返神经麻痹发生率为25%（5例中有4例为短暂性），2例因肿瘤床术后出血而行开胸手术。未发生吻合口漏。术后30天死亡率为15%，院内死亡率为20%。使用该器械未引发上述任何并发症。1例患者食管癌与气管粘连，气管受损。胸段食管游离过程中未观察到低血压或心律失常的发生。纵隔失血不明显。剥离治疗是一种姑息性治疗，无法进行根治性治疗尝试。该器械在上段和中段食管病变中禁用，也不适用于像贲门失弛缓症那样的粗大食管的剥离。
食管剥离器使正常胸段食管的游离变得更容易且耗时更少，且未出现低血压或心律失常情况。
