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中华胸部外科电子杂志 ›› 2020, Vol. 07 ›› Issue (03) : 140 -145. doi: 10.3877/cma.j.issn.2095-8773.2020.03.03

所属专题: 文献

论著

经腹腔镜微创治疗膈上食管憩室
姜皓耀1, 杨煜1, 孙益峰1, 华荣1, 郭旭峰1, 李志刚1,()   
  1. 1. 200030 上海,上海市胸科医院/上海交通大学附属胸科医院-食管外科
  • 收稿日期:2020-08-03 修回日期:2020-08-26 接受日期:2020-08-27 出版日期:2020-08-28
  • 通信作者: 李志刚

Laparoscopic transhiatal treatment of esophageal diverticula in an epiphrenic location

Haoyao Jiang1, Yu Yang1, Yifeng Sun1, Rong Hua1, Xufeng Guo1, Zhigang Li1,()   

  1. 1. Section of Esophageal Surgery, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Received:2020-08-03 Revised:2020-08-26 Accepted:2020-08-27 Published:2020-08-28
  • Corresponding author: Zhigang Li
  • About author:
    Corresponding author: Li Zhigang, Email:
引用本文:

姜皓耀, 杨煜, 孙益峰, 华荣, 郭旭峰, 李志刚. 经腹腔镜微创治疗膈上食管憩室[J]. 中华胸部外科电子杂志, 2020, 07(03): 140-145.

Haoyao Jiang, Yu Yang, Yifeng Sun, Rong Hua, Xufeng Guo, Zhigang Li. Laparoscopic transhiatal treatment of esophageal diverticula in an epiphrenic location[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2020, 07(03): 140-145.

目的

探讨经腹腔镜微创治疗膈上食管憩室的可行性与有效性。

方法

回顾性分析2015年1月至2020年6月于上海市胸科医院治疗的31例食管憩室患者,分析其中13例膈上食管憩室。术前辅助诊断检查包括钡餐造影、上消化道内镜检查、24 h食管pH监测以及食道Manometry测压。手术方式包括病例1~2经左胸开放,病例3经右胸腔镜,病例4~13经腹腔镜裂孔完成。术后观察指标包括手术相关并发症以及症状缓解情况。

结果

13例膈上食管憩室中男7名(53.8%),年龄(64.08±5.9)岁,10例(76.9%)憩室朝向食管左侧壁,憩室颈上缘距门齿距离(35.8±2.0)cm,憩室体直径(4.5±1.7)cm。13例患者接受手术治疗,手术时间(122.1±45.7)min,手术失血量(115.4±60.5)mL,住院时间(10.0±3.4) d。术后发生食管瘘3例,左胸(50%)、右胸(100%)、经腹(10%)路径各1例,其中2例经胸瘘患者均需二次手术。无院内死亡。远期随访可见左胸路径术后有1例患者出现食管狭窄,右胸路径术后1例患者出现反流,腹腔镜术后有2例患者出现食管狭窄。

结论

腹腔镜经裂孔治疗膈上食管憩室,可以极大地提高手术安全性,通过解除远端梗阻,极大地降低术后瘘和憩室复发的发生率。

Objective

To investigate the feasibility and effectiveness of laparoscopic minimally invasive treatment of epiphrenic diverticula.

Methods

Thirty-one patients with esophageal diverticula treated in Shanghai Chest Hospital from January 2015 to June 2020 were retrospectively analyzed, including 13 cases of epiphrenic diverticula. Preoperative diagnostic examinations included barium esophagram, upper gastrointestinal endoscopy, 24-hour esophageal pH monitoring and manometry. Cases 1-2 were performed via a left thoracotomy, Case 3 via a right thoracoscope, and Cases 4-13 via a laparoscopic hiatus. Postoperative observation indexes included operation related complications and symptom relief.

Results

Among the 13 cases, 7 (53.8%) were male, and the age was (64.08±5.9) years. The diverticula in 10 cases (76.9%) were oriented to the left esophageal wall. The distance between the diverticulum neck and the incisor teeth was (35.8±2.0) cm, and the diameter of the diverticulum was (4.5±1.7) cm. The operation time was (122.1±45.7) min, the blood loss was (115.4±60.5) mL, and the hospital stay was (10.0±3.4) days. The esophageal fistula occurred in 3 cases postoperatively, including 1 case via a left thoracotomy (50%) , 1 case via a right thoracoscope (100%) and 1 case via a transabdominal (10%) pathway. Two cases with esophageal fistula needed reoperation. There was no in-hospital mortality. Long-term follow-up showed that 1 patient had esophageal stenosis after left thoracic pathway, 1 patient had reflux after right thoracic pathway, and 2 patients had esophageal stenosis after laparoscopic surgery.

Conclusion

Laparoscopic transhiatal treatment of epiphrenic diverticula can greatly improve the safety of the operation and reduce the possibility of postoperative fistula and recurrence of diverticula by relieving the distal obstruction.

表1 2015—2020上海市胸科医院治疗食管憩室类型
图1 腹腔镜手术打孔设置
图2 经腹腔镜裂孔膈上食管憩室切除+Heller肌层切开+Dor胃底折叠。A.经裂孔显露憩室;B.直线切割缝合器切线位切除憩室;C.食管肌层切开;D.Dor胃底折叠
图3 10例经腹腔镜切除食管憩室患者的憩室位置照片,可见2例朝右,8例朝左
表2 食管下段食管憩室患者基本特征
表3 手术治疗食管下段憩室围术期特征
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