Open or minimally invasive esophagectomy: are the outcomes different?
Open or minimally invasive esophagectomy: are the outcomes different?
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开放式或微创食管切除术：结果有何不同？
DOI：
10.1097/aco.0b013e32831cef4b
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
J. Bussières
中科院分区：
文献类型：
--
作者：
J. Bussières
综述目的自20世纪90年代初以来，微创食管切除术而不是开放技术的使用有所增加。这种方法是否应该改变我们对癌症食管切除术患者的麻醉管理方式？最近的发现由于缺乏与开放手术的有效直接比较，因此无法对微创手术的潜在益处做出明确的声明。与最近开放手术报告的粗略比较表明，降低死亡率、呼吸系统并发症和失血量，加上更快地恢复良好的生活质量，是微创手术可能被证明具有上级优势的领域。泄漏率与开放手术报告的泄漏率相似。令人惊讶的是，两种技术的住院时间和总体发病率相似。报告的手术时间似乎长于开放手术，这反映了腹腔镜手术在其他领域的经验。摘要尽管缺乏随机对照试验，微创食管切除术的植入似乎是不可避免的。在微创食管切除术中使用俯卧位单肺通气似乎是积极的。单肺通气期间的保护性通气可能有助于预防肺部并发症。最后，广为接受的胸段硬膜外麻醉的使用现在在食管切除术后发挥了新的积极作用，改善了吻合口水平的灌注。
Purpose of review Since the beginning of the 1990s, the use of minimally invasive esophagectomy instead of the open technique has increased. Should this type of approach change the way we manage anesthesia for a patient undergoing esophagectomy for cancer? Recent findings Because valid direct comparisons with open surgery are lacking, one cannot make definitive statements regarding the potential benefits of minimally invasive surgery. Rough comparisons with recent reports on open surgery suggest that reduced mortality, respiratory complications and blood loss, plus a more rapid return to a good quality of life are areas in which minimally invasive surgery might prove superior. Leak rates were similar to those reported with open procedures. Surprisingly, length of hospital stay and overall morbidity are similar with both techniques. Reported operating times appear longer than one might expect for open operations, which mirrors the experience of laparoscopic procedures in other areas. Summary The implantation of minimally invasive esophagectomy seems inevitable in spite of the absence of randomized, controlled trials. The use of the prone position with one lung ventilation during minimally invasive esophagectomy seems positive. Protective ventilation during one lung ventilation may help to prevent pulmonary complications. Finally, the well accepted use of thoracic epidural anesthesia now has a new positive role following esophagectomy, improving the perfusion at the anastomotic level.
影响因子：
9
作者：
Luketich, JD;Alvelo-Rivera, M;Fernando, HC
通讯作者：
Fernando, HC
影响因子：
254.7
作者：
Jemal, Ahmedin;Siegel, Rebecca;Thun, Michael J.
通讯作者：
Thun, Michael J.