Introducere: In cazul tumorilor maligne esofagiene polare superioare, faringoesofagiene si de vecinătate cu interesarea hipofaringelui şi esofagului,
aflate în stadii depăsite chirurgical, protezarea presupune problemele tehnice deosebite. Material şi metodă: Am realizat endoprotezarea esofagiană
prin abord laparogastroscopic (procedeu original, brevetat premiat in Japonia în 2005), la 30 de pacienți cu stenoze maligne esofagiene cervicale şi
faringoesofagiene, la care cateterizarea endoscopică ortogradă a fost imposibilă, toți fiind propusi pentru gastrostomie. Rezultate: Pacienții se aflau în
stadii avansate, cu diseminări la distanță şi caşexie. Localizarile esofagiene polare superioare (23 cazuri) în special cele faringoesofagiene (7 cazuri)
prezinta particularitati care ingreuneaza protezarea datorita vecinatatii laringelui si riscului de aspiratie. La aceste cazuri am utilizat un tip particular
de proteză. Bolnavii canulati postlaringectomie reprezinta un esantion special. Concluzii: Procedeul original laparogastroscopic protetic miniinvaziv,
presupune o agresiune redusă, abordul fiind cu montarea protezei prin tracțiune nu prin împingere ca în procedeele endoscopice. Procedeul nostru a
permis protezarea în localizări înalte, considerate de unii autori imposibil de protezat.
Aims: Upper polar esophageal malignant tumors, pharyngo-esophageal malignant tumors and vicinity malignant tumors involving the hypopharynx
and the esophagus, in inoperable stages, pose serious technical problems in the case of prosthesing. Method: We have performed an esophageal endoprosthesing through a laparogastroscopic approach (an original, innovative procedure internationally awarded in Japan, in 2005) on 30 patients with
cervical and pharyngo-esophageal malignant stenoses. The ortograde endoscopic insertion of a catheter was impossible on these patients, all of them
being proposed for gastrostomy. Results: The patients were in advanced stages, with distant disseminations and cachexy. Upper polar esophageal
locations (in 23 cases), especially the pharyngo-esophageal ones (in 7 cases), presented particularities that made prosthesing very difficult, because of
the vicinity of the larynx and the risk of aspiration. In these cases we used a special type of prosthesis. A particular group is made up by the patients
who were cannulated post laryngotomy. Conclusions: This prosthetic mini-invasive procedure is a less aggressive one; the approach is gastroscopic,
the prosthesis being inserted by traction, and not by pushing, as in the endoscopic procedures. Our original procedure allows for prosthesis placement
in upper locations in which, according to some authors, prosthesing is not possible.
