ObjectiveTo explore the feasibility of decompression without gastric tube after minimally invasive esophageal cancer surgery.MethodsSeventy-two patients who underwent minimally invasive esophageal cancer resection at the Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University from 2016 to 2018 were selected as a trial group including 68 males and 4 females with an average age of 58.5±7.9 years, who did not use gastric tube for gastrointestinal decompression after surgery. Seventy patients who underwent the same operation from 2013 to 2015 were selected as the control group, including 68 males and 2 females, with an average age of 59.1±6.9 years, who were indwelled with gastric tube for decompression after surgery. We observed and compared the intraoperative and postoperative indicators and complications of the two groups.ResultsThere were no significant differences between the two groups in operation time, intraoperative blood loss, postoperative level of serum albumin, postoperative nasal jejunal nutrition, whether to enter the ICU postoperatively, death within 30 days after surgery, anastomotic leakage, lung infection, vomiting, bloating or hoarseness (P>0.05). No gastroparesis occurred in either group. Compared with the control group, the recovery time of the bowel sounds and the first exhaust time after the indwelling in the trial group were significantly shorter, and the total hospitalization cost, the incidence of nausea, sore throat, cough, foreign body sensation and sputum difficulty were significantly lower (P<0.05).ConclusionIt is feasible to remove the gastric tube for gastrointestinal decompression after minimally invasive esophageal cancer surgery, which will not increase the incidence of postoperative complications, instead, accelerate the postoperative recovery of patients.
Reconstruction and repair of atresia or defect of the upper portion of esophagus is difficult. From November 1980 to December 1997, forth-five cases, consisting 35 males and 10 females, were treated with microsurgical technique. The 45 patients fell into the following groups as esophageal atresia of various causes in 21 cases, anastomotic fistula or stenosis following reconstruction of esophagus in 7 cases and late carcinoma of esophagus in 17 cases. The types of reconstruction consisted of transfer of free jejunum with its lower portion carrying a vascular pedicle in 24 cases, free transfer of jejunal graft in 15 cases, free vascularized jejunal graft in 2 cases and free vascularized tubular skin graft in 4 cases. After a follow-up of 6-19 months besides eight cases died from late esophageal carcinoma, thirty-seven cases were survived and could take food by mouth. All of the benign cases could return to work. In patients having late esophageal carcinoma, the operative procedure could improve the life quality and facilitate chemotherapy and radiotherapy.
Mini-invasive video-assisted thoracoscopic surgery (VATS) has been employed in diagnosis and treatment of esophageal diseases for about 10 years. The potential advantages of VATS over thoracotomy are reduction of chest pain just after the operation and in the long run, lower incidence of postoperative respiratory complications, and reduction of aesthetic sequelae. Thoracoscopic staging of esophageal cancer is to evaluate the invasion and metastasis of cancer, which is helpful for better selection of patients for appropriate treatment .Operation of esophageal cancer with VATS is prescribed mainly in the early stage of carcinoma, but it’s application is restricted due to the multiple sites of operation and complexity of procedures. VATS for benign esophageal diseases such as esophageal leiomyoma and achalasia is becoming the preferable choice of operation in qualified medical centers.
Abstract: Objective To evaluate the effect on gastroesophageal reflux and gastric emptying in the different route of gastroesophageal anastomosis objectively after esophagectomy for patients with midesophageal carcinoma. Methods Forty patients with midesophageal carcinoma were randomly divided into two groups. Esophageal bed group (n=20): the gastroesophageal anastomosis were performed while the stomach were pulled on through the esophageal bed after esophagectomy; endothoracic group (n=20): gastroesophageal anastomosis were performed while the stomach were pulled on in the thoracic cavity. Ten persons had no disease of digestive system and healthy volunteers were recruited as normal control group. 24-hour esophageal pH monitoring and radioisotope gastric emptying checkup were carried out in all experimental subjects 3 months after operation, so as to observe the changes of gastroesophageal reflux and gastric emptying. Results All of the patients’s operation were success. And no anastomotic leakage and no anastomotic stenosis. Three months after operation, the patients in both operation groups were with different level of reflux. DeMeester total appraise score, the times of regurgitation of gastric juice in 24h, gt;5 min reflux frequency, the longest time of keep reflux, pHlt;4.00 total time and pHlt;4.00 of total time percent, these targets in both operation groups were higher than those in control group (Plt;0.01) DeMeester total appraise score, the times of regurgitation of gastric juice in 24 hours, the longest time of keeping reflux, pHlt;4.00 of total time and pHlt;4.00 of total time percent in esophageal bed group were lower than those in endothoracic group(Plt;0.01). The recent period of gastric emptying percentage (GE) in both operative groups were lower than that in normal control group. GE in esophageal bed group experimental meal in the stomach after entering the 30,60,90,120,180 and 240 min were higher than those in endothoracic group. Conclusion After the operation of esophagogastric anastomosis through esophageal bed in upper aortic site,gastroesophageal reflux and delayed gastric emptying exist objectively, However, the technique is superior to the traditional technique to reduce the extent of gastroesophageal reflux and delayed gastric emptying, its mechanism might be the result of mechanical factors.