The Cause of the Respiratory Complications Following Combined Usage Laparoscopic and Thoracoscopic Esophagec-tomy in Perioperative Stage and the Strategy of Prevention
DONG Guo-hua
YAO Sheng
WU Hai-wei
LI Zong-jie
LIU Can-hui
SUN Lei
Abstract：Objective To summarize the damage to the respiratory system and the cause of perioperative complications by combined usage of the laparoscopic and thoracoscopic esophagectomy and discuss the strategy of prevention and treatment. Methods Clinical data of 16 patients, undergoing a minimally invasive esophagogastectomy in our department and with damage to the respir-atory system and related complications during July 2012 and July 2013 were recalled. The factors of harm to the respiratory system, complications and clinical features during the perioperative period were summed up. Results The complete surgical method was ex-cision of esophageal cancer with the laparoscopic and thoracoscopic and anastomotic operation of oesophagus-tubulous stomach at the neck. In the early stage, 5 cases of operation applied double lumen tube intubation, and 2 of them had the damage to trachea and bronchus during the cannula of dual cavity bronchus. We finished the repair under the thoracoscope, and the patients recovered to normal conditions after operation; the other 11 patients underwent the operations of single-lumen endotracheal tube and artificial pneumothorax, with no obvious damage to respiratory system. In this group there was no transit thoracotomy or laparotomy. 14 cases of this group suffered from postoperative complications, and 3 patients had hoarse voices and concurrent pulmonary infection. The laryngeal mirror proved that it was paralysis of left vocal cord. They recovered and were discharged after conservative treatment. 3 cases had chylopleura and a great amount of hydrothorax, 1 case received the expectant treatment, the other 2 had ligatured the duc-tus thoracicus under the thoracoscope again, and both of them were successfully cured. 4 cases had simply pulmonary infection, and were successfully cured after administration of antibiotics, the other 4 cases suffered from the severe pulmonary infection complicated by prostration of respiratory function. The trachea was cut open and the breathing machine was used for assisted respiration, 1 case was given conservative treatment to heal, 3 cases had anastomotic fistula,and were cured using the esophageal fistula tube and the chest tube drainage. The remaining 1 patient had the complicated trachea-esophageal fistula and died. Conclusion The damage to respiratory system is a vital complication caused by combined usage of the laparoscopic and thoracoscopic esophagectomy during the perioperative period, which could be prevented by perioperative atomization and single-lumen endotracheal tube and artificial pneu-mothorax and more attention should be paid to the nerve protection in intraoperative period.
Keywords：Esophageal neoplasmThoracoscopyLaparoscopyWound and injuryRespiratory systemPeriopera-tive period
Publication Date：2016-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 63-66 )