Video-thoracoscopic approach, without suture, of late thoracic esophageal perforations

ABSTRACT Objectives: to evaluate the use of video-thoracoscopy, in the treatment of late perforations of the thoracic esophagus, without suture or organ resection. Methods: retrospective analysis of patients with late diagnosis (> 12 hours) of thoracic esophageal perforation treated by video-thoracoscopy, without suture or organ resection, over a 15-year period. Results: sixteen patients were operated on, ten men and six women, aged between 48 and 66 years, with time between the diagnosis of the perforation and the surgery ranging from 16 to 26 hours. All patients underwent video-thoracoscopy, with pulmonary decortication, pleural loculations approach, opening of the mediastinal pleura near the perforation site and debridement of the devitalized tissues, followed by double drainage of the pleural cavity. No esophageal suture or resection was performed, and the patients evolved with complete closure of the lesions, without deaths. Conclusion: the video-thoracoscopic surgical approach was able to control pleural infection, pulmonary expansion and enable complete regeneration of the esophagus with late-diagnosed perforation.摘要 研究目的：评估电视胸腔镜手术（video-thoracoscopy）在无需缝合或器官切除的前提下，治疗胸食管迟发性穿孔的应用价值。 方法：回顾性分析15年间收治的、经电视胸腔镜手术治疗且未行缝合或器官切除的迟发性（诊断时间＞12小时）胸食管穿孔患者的临床资料。 结果：本研究共纳入16例患者，其中男性10例、女性6例，年龄区间为48~66岁；穿孔诊断至手术的时间间隔为16~26小时。所有患者均接受电视胸腔镜手术，术中依次实施肺胸膜剥脱术、胸膜腔分隔松解术、穿孔区域附近纵隔胸膜切开术以及失活组织清创术，随后对胸膜腔进行双重引流。所有患者均未行食管缝合或切除操作，术后病灶完全闭合，无死亡病例发生。 结论：针对诊断延迟的胸食管穿孔患者，电视胸腔镜手术入路可有效控制胸膜腔感染、促进肺复张，并实现食管的完全再生修复。