Buess G, Kaiser J, Manncke K, Walter D H, Bessell J R, Becker H D
Section for Minimal Invasive Surgery, University of Tübingen, Germany.
Int Surg. 1997 Apr-Jun;82(2):109-12.
This paper presents endoscopic microsurgical dissection of the esophagus (EMDE), a surgical technique for the therapy of esophageal cancer which improves blunt esophageal dissection with the aim of reducing postoperative morbidity and mortality. A mediastinoscope with integrated operative instrument channel, fibre bundles, optic and rinsing channel has been developed whereby precise and atraumatic esophageal dissection is possible via a cervical access incision. Between 1989 and 1993, 37 patients were operated on using the EMDE technique and are compared with 48 patients operated on during the same period by the thoraco-abdominal route. The operative duration was reduced by the new technique, and although the number of severe complications was not significantly different between both groups, the rate of pulmonary and cardiac complications was reduced. The mortality rate was 10% for EMDE patients and 14% for the thoraco-abdominal procedure, and there was no difference in the long-term survival rate. As distinct from procedures requiring a thoracotomy for esophageal dissection, EMDE permits ventilation of both lungs throughout the entire operation and reduces the total operative trauma.
本文介绍了食管内镜显微手术解剖术（EMDE），这是一种治疗食管癌的外科技术，通过改进钝性食管解剖，旨在降低术后发病率和死亡率。已研发出一种带有集成手术器械通道、纤维束、光学和冲洗通道的纵隔镜，通过颈部入路切口可实现精确且无创的食管解剖。1989年至1993年间，37例患者采用EMDE技术进行手术，并与同期48例经胸腹途径手术的患者进行比较。新技术缩短了手术时间，尽管两组严重并发症的数量无显著差异，但肺部和心脏并发症的发生率有所降低。EMDE患者的死亡率为10%，胸腹手术患者的死亡率为14%，长期生存率无差异。与需要开胸进行食管解剖的手术不同，EMDE在整个手术过程中允许双肺通气，并减少了总的手术创伤。
