Davis E A, Heitmiller R F
Department of General Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Ann Thorac Surg. 1996 Aug;62(2):369-72.
Esophagectomy for benign disease is uncommon.
From July 1987 to April 1995, 45 consecutive patients (30 men, 15 women; mean age, 50 years) were evaluated in whom the senior author (R.F.H.) performed an esophagectomy, esophageal reconstruction, or both. The study period was divided into two time intervals, July 1987 to January 1992 (time 1) and February 1992 to April 1995 (time 2).
Indications for operation included obstruction (23 patients, 51%), benign neoplasia (17.38%), and perforation (5 patients, 11%). A nonthoracotomy approach was used in 19 (42%) patients: 15 transhiatal and 4 substernal. Thoracotomies were performed in 26 (58%) patients through a left thoracoabdominal or multiincisional techniques. Morbidity occurred in 15 (33%) patients, and there was one operative death (2%).
Despite an operative morbidity of 33%, esophagectomy for benign disease may be performed with acceptably low mortality. We observed the following trends: (1) an increase in patients with benign neoplasia and a decline in patients with obstruction, (2) an increased use of transhiatal esophagectomy, (3) a decreased use of colon, an increased use of stomach for esophageal replacement; and (4) a decreased length of hospital stay.
因良性疾病行食管切除术并不常见。
1987年7月至1995年4月，连续对45例患者（30例男性，15例女性；平均年龄50岁）进行评估，这些患者均接受了资深作者（R.F.H.）实施的食管切除术、食管重建术或两者联合手术。研究期分为两个时间段，1987年7月至1992年1月（时间段1）和1992年2月至1995年4月（时间段2）。
手术指征包括梗阻（23例患者，51%）、良性肿瘤（17.38%）和穿孔（5例患者，11%）。19例（42%）患者采用非开胸手术方法：15例经裂孔手术，4例经胸骨后手术。26例（58%）患者通过左胸腹联合或多切口技术进行开胸手术。15例（33%）患者发生并发症，有1例手术死亡（2%）。
尽管手术并发症发生率为33%，但因良性疾病行食管切除术的死亡率可能低至可接受水平。我们观察到以下趋势：（1）良性肿瘤患者增加，梗阻患者减少；（2）经裂孔食管切除术的使用增加；（3）结肠使用减少，胃用于食管替代的使用增加；（4）住院时间缩短。
