Magyar sebeszet · 2008
[Laparoscopic transhiatal resection of esophageal cancer].
Клинический случайАннотация на английскомСтатьяОбзорНазвание и аннотация: Перевод в очереди
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Lukovich Péter, Papp András, Nehéz László, Nagy Katalin, Kupcsulik Péter
Аннотация
INTRODUCTION: Minimally invasive oesophageal resection is a real alternative to the conventional open operative techniques in the surgical treatment of oesophageal tumours.
PATIENT AND METHOD: The authors present a case of a 51 year-old female patient who initially underwent an upper GI endoscopy for vague stomach symptoms. The examination revealed an oesophageal tumour of approximately 2 cm in length, located at 32 cm from the incisors. Abdominal ultrasound and CT scans were carried out, which showed that the tumour had breached the submucosa, but regional lymph node metastasis was not detected. Since an intraluminal flexible endoscopic ablation of the tumour could not have been carried out, a laparoscopic transhiatal oesophagus excision was done. The oesophagus was replaced by an intracorporal tubulated stomach in the posterior mediastinum.
RESULT: In the postoperative period a gastro-pleural fistula developed in the middle third of the stomach, which was treated conservatively (thoracic drainage, Salem probe). A phlegmone developed next to the feeding jejunostomy - at the site of one of the trocars - required exploration, the re-suturing of the jejunostomy due to persisting leakage of the small intestine. 3 months after the operation the patient was asymptomatic and gained 2 kg weight.
CONCLUSION: Laparoscopic transhiatal oesophagus resection has all the benefits of the minimally invasive techniques; in addition, it makes possible to do a more radical surgery than with the traditional transhiatal operation. The authors review the relevant literature and present other minimal invasive techniques, discussing the results on lymph node dissection, pyloroplasty, as well as replacement.
PATIENT AND METHOD: The authors present a case of a 51 year-old female patient who initially underwent an upper GI endoscopy for vague stomach symptoms. The examination revealed an oesophageal tumour of approximately 2 cm in length, located at 32 cm from the incisors. Abdominal ultrasound and CT scans were carried out, which showed that the tumour had breached the submucosa, but regional lymph node metastasis was not detected. Since an intraluminal flexible endoscopic ablation of the tumour could not have been carried out, a laparoscopic transhiatal oesophagus excision was done. The oesophagus was replaced by an intracorporal tubulated stomach in the posterior mediastinum.
RESULT: In the postoperative period a gastro-pleural fistula developed in the middle third of the stomach, which was treated conservatively (thoracic drainage, Salem probe). A phlegmone developed next to the feeding jejunostomy - at the site of one of the trocars - required exploration, the re-suturing of the jejunostomy due to persisting leakage of the small intestine. 3 months after the operation the patient was asymptomatic and gained 2 kg weight.
CONCLUSION: Laparoscopic transhiatal oesophagus resection has all the benefits of the minimally invasive techniques; in addition, it makes possible to do a more radical surgery than with the traditional transhiatal operation. The authors review the relevant literature and present other minimal invasive techniques, discussing the results on lymph node dissection, pyloroplasty, as well as replacement.