Early and long-term morbidity after minimally invasive total laryngo-pharyngo-esophagectomy with gastric pull-up reconstruction via thoracoscopy, laparoscopy and cervical incision
Early and long-term morbidity after minimally invasive total laryngo-pharyngo-esophagectomy with gastric pull-up reconstruction via thoracoscopy, laparoscopy and cervical incision
复制标题
DOI：
10.1007/s00405-014-3420-9
复制
发表时间：
2015-11-01
影响因子：
2.6
通讯作者：
Fukuda, Satoshi
中科院分区：
文献类型：
--
作者：
Homma, Akihiro;Nakamaru, Yuji;Fukuda, Satoshi
全喉-咽-食管切除术（TLPE）联合胃上拉重建仍被认为与严重并发症和院内死亡的显著风险相关。微创食管切除术，避免开胸手术和剖腹手术，已越来越多地用于食管恶性肿瘤，希望降低死亡率和发病率，如肺部并发症。本研究的目的是评估经胸腔镜、腹腔镜和颈部切口行TLPE胃上拉重建术患者的早期和长期发病率以及治疗结局。从2004年至2013年，10例中位年龄为64岁（范围47-71岁）的患者接受了微创TPLE和胃上拉重建术。10例患者中有7例既往接受过放疗。术后早期并发症：肺炎1例，皮肤坏死1例，伪膜性小肠结肠炎1例，心律失常2例，颈部出血2例，颈部吻合口瘘3例，气管坏死6例。3例患者发生气管造口狭窄作为长期术后并发症，1例患者观察到吻合口狭窄。所有患者均能够实现经口进食，但3例患者需要饲管支持。总之，尽管经常观察到气管坏死和吻合口瘘等伤口并发症，但认为术后早期的术后全身并发症是可接受的。因此，这种微创手术可能有助于降低需要TLPE胃上拉重建的患者的死亡率和发病率。
Total laryngo-pharyngo-esophagectomy (TLPE) with gastric pull-up reconstruction is still considered to be associated with major complications and a significant risk of in-hospital death. Minimally invasive esophagectomy, avoiding thoracotomy and laparotomy, has been increasingly performed for esophageal malignancies with the hope of reducing mortality and morbidity, such as pulmonary complications. The aim in this study was to assess early and long-term morbidity as well as treatment outcomes in patients treated with TLPE with gastric pull-up reconstruction via thoracoscopy, laparoscopy and cervical incision. From 2004 to 2013, 10 patients with a median age of 64 years (range 47-71 years) underwent minimally invasive TPLE with gastric pull-up reconstruction. Seven of the 10 patients had previously received radiotherapy. As for early postoperative complications, no patient died during the early postoperative period, and pneumonia was observed in 1, skin necrosis in 1, pseudomembranous enterocolitis in 1, arrhythmia in 2, hemorrhage in the neck in 2, anastomotic leakage in the neck in 3, and tracheal necrosis in 6 patients. Three patients developed tracheostomal stenosis as a long-term postoperative complication, and an anastomotic stricture was observed in one patient. All patients were able to achieve oral intake, but 3 patients required feeding tube support. In conclusion, postoperative systemic complications during the early postoperative period were considered to be acceptable, although wound complications such as tracheal necrosis and anastomotic leakage were commonly observed. Therefore, this minimally invasive procedure might help reduce mortality and morbidity in patients requiring TLPE with gastric pull-up reconstruction.