Peracchia A, Fumagalli U, Rosati R
Klinik für Allgemeine Chirurgie und chirurgische Onkologie, Universität Mailand, Italien.
Chirurg. 1994 Aug;65(8):671-6.
Some malignant and benign diseases of the esophagus are generally treated through a thoracotomic approach. While this may be justified in the curative treatment of cancer, thoracotomy may be avoided for benign diseases if good functional results can be obtained through a minimally invasive approach. Long-term results with careful clinical and manometric monitoring of patients operated on for epiphrenic diverticula have to be considered to define the possible role of thoracoscopic approach to this disease since a laparoscopic approach, which includes transhiatal diverticulectomy, myotomy, and fundoplication, seems to have excellent results. As for leiomyomas thoracoscopy represents the first choice approach since it allows a complete removal of the benign tumor with a limited access. In case of malignant diseases, thoracoscopic esophagectomy has in our opinion few indications. Extent of lymphnodal dissection appears to be the major limiting factor of the technique. Moreover, high-risk patients need anyway a double-lumen intubation and a prolonged single-lung ventilation. Modifications of respiratory function after thoracoscopy have to be compared with those occurring after thoracotomy and after transhiatal esophagectomy. Studies on lymphadenectomy and on respiratory physiopathology will help in define a possible role of this approach.
一些食管的恶性和良性疾病通常通过开胸手术进行治疗。虽然这在癌症的根治性治疗中可能是合理的，但对于良性疾病，如果通过微创方法能够获得良好的功能结果，则可以避免开胸手术。对于接受膈上憩室手术的患者，必须考虑通过仔细的临床和测压监测获得的长期结果，以确定胸腔镜手术治疗该疾病的可能作用，因为包括经裂孔憩室切除术、肌切开术和胃底折叠术在内的腹腔镜手术似乎有出色的效果。至于平滑肌瘤，胸腔镜检查是首选方法，因为它可以在有限的入路下完整切除良性肿瘤。对于恶性疾病，我们认为胸腔镜食管切除术的适应证很少。淋巴结清扫范围似乎是该技术的主要限制因素。此外，高危患者无论如何都需要双腔插管和长时间的单肺通气。胸腔镜检查后呼吸功能的改变必须与开胸手术和经裂孔食管切除术后发生的改变进行比较。关于淋巴结清扫和呼吸生理病理学的研究将有助于确定这种方法的可能作用。
