Alegerea metodei de tratamentul chirurgical optimal al diverticulilor esofagieni

Abstract

Rezumat. Introducere. Apariția pungii diverticulare esofagiene este condiționată de mulți factori: hiperpresiune intraesofagiana, tulburări de motilitate esofagiană, procese inflamatorii paraesofagiene - elemente ce acționează asupra unei zone anatomice de slabă rezistenţă parietală. O parte de pacienți care manifestă semnele clinice specifice necesită corecția chirurgicală. Material şi metode. În perioada 2000-2010 în secția chirurgie toracică SCR s-au aflat la tratament 41 pacienți cu diverticul esofagian. Topografic au fost diagnosticați diverticuli esofagieni cervicali – 27 (66%), bifurcaționali – 10 (24%) și epifrenali – 4 (10%) – ce corespunde datelor statistice din literatură. La 34 pacienți a fost efectuată intervenția chirurgicală. În majoritatea cazurilor (31 pacienți 91,2%) s-a practicat diverticulectomie prin abord cervical și toracic tradițional respectând detaliile tehnice specifice, în funcție de topografia pungii diverticulare. În 3 (8,8%) cazuri de localizare a diverticulului esofagian intratoracic s-a aplicat tratament chirurgical videotoracoscopic. Rezultate. Mortalitatea postoperatorie a fost nulă. Printre complicații postoperatorii precoce s- au întâlnit 2 cazuri de pleurezie exudativă rezolvată prin toracocenteză și 2 pacienți au avut disfagie temporară tratată medicamentos. În perioada de supraveghere medie de 5 ani complicații tardive și recidive nu au fost înregistrate. Concluzii. Tratamentul electiv al diverticulului esofagian este chirurgical și impune proceduri operatorii specifice și complexe, momentul determinant fiind particularitățile mobilizării colului diverticular. Diverticulectomia videotoracoscopică – etapa noua și de perspectivă în tratamentul diverticulului esofagian.

Background. The appearance of esophageal diverticula is caused by several factors: intraesophageal hypertension, disturbance of esophageal motility, paraesophageal inflammation -all acting on the anatomic zones with weak parietal resistance. Some patients with specific clinical signs need surgical correction of this condition. Material and methods. In the period 2000-2010 in the department of thoracic surgery, Clinical Republican Hospital 41 patients were diagnosticated with esophageal diverticulum. Repartition of the patients according to diverticula topography as follows: cervical – 27 (66%), mid-esophageal – 10 (24%) and epiphrenic – 4 patients (10%) – this corresponds to observations from other studies. In 34 patients a surgical intervention was performed. In majority of cases (31 cases – 91.2%) a traditional diverticulectomy was used with cervical or thoracic approach depending on the topography of the diverticular pouch. In 3 cases (8,8%) of mid-esophageal diverticulum a video-assisted thoracoscopic surgery was performed. Results. No postoperative lethality was registered. Among early postoperative complications 2 cases of exudative pleurisy were observed and solved by thoracocentesis. Other 2 patients had temporary dysphagia treated conservatively. During the mean follow-up of 5 years late complications or recurrences were not registered. Conclusions. Surgery is elective treatment of esophageal diverticula, which needs specific and complex operative procedures. The main element of the intervention is proper dissection of the diverticular neck. Video-assisted thoracoscopic diverticulectomy opens new perspectives in the treatment esophageal diverticula.

Background. The appearance of esophageal diverticula is caused by several factors: intraesophageal hypertension, disturbance of esophageal motility, paraesophageal inflammation -all acting on the anatomic zones with weak parietal resistance. Some patients with specific clinical signs need surgical correction of this condition. Material and methods. In the period 2000-2010 in the department of thoracic surgery, Clinical Republican Hospital 41 patients were diagnosticated with esophageal diverticulum. Repartition of the patients according to diverticula topography as follows: cervical – 27 (66%), mid-esophageal – 10 (24%) and epiphrenic – 4 patients (10%) – this corresponds to observations from other studies. In 34 patients a surgical intervention was performed. In majority of cases (31 cases – 91.2%) a traditional diverticulectomy was used with cervical or thoracic approach depending on the topography of the diverticular pouch. In 3 cases (8,8%) of mid-esophageal diverticulum a video-assisted thoracoscopic surgery was performed. Results. No postoperative lethality was registered. Among early postoperative complications 2 cases of exudative pleurisy were observed and solved by thoracocentesis. Other 2 patients had temporary dysphagia treated conservatively. During the mean follow-up of 5 years late complications or recurrences were not registered. Conclusions. Surgery is elective treatment of esophageal diverticula, which needs specific and complex operative procedures. The main element of the intervention is proper dissection of the diverticular neck. Video-assisted thoracoscopic diverticulectomy opens new perspectives in the treatment esophageal diverticula.