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（video-thoracoscopy）在无需缝合或器官切除的前提下，用于治疗迟发性胸食管穿孔的临床应用价值。
研究方法：对15年期间内收治的、确诊延迟（＞12小时）且接受电视胸腔镜手术治疗、未行食管缝合或器官切除的胸食管穿孔患者开展回顾性分析。
研究结果：共纳入16例患者，其中男性10例、女性6例，年龄介于48至66岁之间；穿孔确诊至手术的时间跨度为16至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、于穿孔部位附近切开纵隔胸膜以及失活组织清创，随后行胸腔双腔引流。所有患者均未接受食管缝合或切除手术，术后病灶均完全闭合，无死亡病例发生。
研究结论：电视胸腔镜手术入路可有效控制胸腔感染、促进肺复张，并能使迟发性确诊的食管穿孔患者实现食管的完全再生修复。