食管良性疾病胸腔镜治疗的并发症

目的：回顾10年来采用电视胸腔镜治疗各类食管良性疾病的并发症，提出减少并发症的措施。方法：回顾分析中山医院院自1994年至2003年采用电视胸腔镜治疗食管良性疾病35例，男性28例，女性7例，年龄28～67岁，平均49．68岁。其中贲门失弛缓症18例。食管平滑肌瘤12例．食管囊肿3例．膈食管憩室伴平滑肌瘤1例，弥漫性食管痉挛1例。所有手术均在胸腔镜配合术中纤维食管镜下完成。统计手术相关并发症。结果：全组无手术死亡。发生并发症6例．其中食管破裂穿孔5例．胸腔感染1例。5例食管破损穿孔术中发现4例。3例在内镜下修补成功，1例术中内镜修补后仍发生穿孔。1例术后1天发现食管穿孔．开胸行食管穿孔修补。胸腔感染患者经胸腔引流及抗感染后治愈。结论：术中食管破裂穿孔是胸腔镜食管手术最常见的并发症．合理改进手术技巧结合术中食管镜是减少并发症的好方法。

Complications of Video-assisted Thoracoscopic Surgery in Treatment of Esophageal Benign Disease

Objective: Complications of our ten-years ex perience of video-assisted thoracoscopic surgery in treatment of esophageal ben ign disease were reviewed in order to find the way to reduce these mortalities. Methods: A retrospective analysis of 35 cases of video-assisted thoracoscopic surgery(VATS) in treating esophageal benign disease from 1994 to 2003 was made. Among them, 28 were male, 7 were female patients. Age ranged from 28 to 67 esophageal cyst, averaged 49.68 esophageal cyst. The disease diversity was 18 cases of achalasia, 12 cases of esophageal leiomyoma, 3 cases of esophag eal cyst, 1 case of diffused esophageal spasm and 1 case of combined esophageal leiomyoma and epiphernic diverticulum. Surgical intervention were succeeded in a ll patients by using VATS combined with endoscopy. Complications were analysed. Results: No surgical related motality was happened in this grou p while complications were happened in 6 cases, including 5 of esophageal perfor ation and 1 simple emphyema. 4 perforations were found at surgery and 3 of them repaired by endo-surgery simultaneously, the other 1 repaired by open procedure . The patient who was found esophageal perforation 1 day postoperatively was reo perated by thoracotomy. Salvage procedures were succeeded in 4 patients except f or 1 fail of endoscopic repairing. 1 simple emphyema was cured by chest tube dr ainage. Conclusion: Surgery related esophageal perforation is th e most common complication in our experience. The best way to reduce this is to improve surgical technique and use endoscopy during VATS esophageal surgery.