胸段食管憩室微创手术的现状：系统评价与荟萃分析。
Current status of minimally invasive surgery for thoracic esophageal diverticula: systematic review and meta-analysis.
文献信息
| PMID | 42850304 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Alberto Aiolfi |
| 作者单位 | Department of General Surgery, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy. alberto.aiolfi86@gmail.com. |
| 期刊 | Surgical endoscopy |
| SCI 分区 | Q1 |
| IF | 3.3 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
引言： 胸段食管憩室，包括膈上型和支气管旁型，是罕见的临床实体，约占所有食管憩室的30%。膨出型胸段憩室传统上与动力障碍相关，对有致残性吞咽困难、反流或肺部误吸症状的患者，采用吻合器憩室切除术并伴或不伴肌切开术/胃底折叠术治疗。本研究的目的是回顾现有文献并评估微创手术的结局。
方法： 系统评价与荟萃分析。检索了PubMed、MEDLINE、Scopus、Web of Science、Cochrane Central Library和ClinicalTrials.gov。检索最后更新于2026年4月20日。结局为吻合线漏、总体并发症、院内死亡率和症状改善。
结果： 分析了21项观察性研究，共390例患者。患者年龄范围为23至83岁。吞咽困难（86%）、反流（73.4%）和呼吸道症状（31.2%）是常见的手术指征。憩室大小为2至11厘米。18项研究报告了术前使用标准或高分辨率食管测压。贲门失弛缓症（49.2%）是最常见的相关动力障碍。描述了腹腔镜（61.9%）、胸腔镜（30.6%）或联合（6.7%）微创入路。辅助手术为食管肌切开术（87%）和Dor（34.6%）或Toupet（17.7%）胃底折叠术。吻合线漏的估计合并患病率为9.8%（95% CrI 7.1-13.4%；I2 = 0.0）。探索性未调整亚组分析未发现根据肌切开术（RR = 0.67；95% CrI 0.17-3.52）或手术入路（RR = 0.72；95% CrI 0.22-3.39）在吻合线漏方面有统计学支持的差异。总体并发症、院内死亡率和研究报告的症状缓解/改善的估计合并患病率分别为21.6%（95% CrI 16.1-28.4%）、1.3%（95% CrI 0.5-2.9%）和92.1%（95% CrI 87.7-95%）。
结论： 目前报告微创中段食管和膈上憩室切除术结局的证据受研究设计和治疗异质性的限制。未来需要设计良好的多中心研究来评估手术入路和食管肌切开术对短期发病率、症状结局和复发率的影响。
英文摘要
INTRODUCTION: Thoracic esophageal diverticula, including epiphrenic and parabronchial types, are rare clinical entities representing about 30% of all esophageal diverticula. Thoracic diverticula of the pulsion type have traditionally been associated with motility disorders and treated by stapled diverticulectomy with or without myotomy/fundoplication in patients experiencing disabling symptoms of dysphagia, regurgitation or pulmonary aspiration. Purpose of this study was to review the existing literature and estimate outcomes of minimally invasive surgery.
METHODS: Systematic review and meta-analysis. PubMed, MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were queried. The search was last updated on April 20, 2026. Outcomes were staple-line leak, overall complications, in-hospital mortality, and symptoms improvement.
RESULTS: Twenty-one observational studies including 390 patients were analyzed. The age of the patients ranged from 23 to 83 years. Dysphagia (86%), regurgitation (73.4%), and respiratory symptoms (31.2%) were common indications for surgery. The size of the diverticula ranged from 2 to 11 cm. Preoperative use of standard or high-resolution esophageal manometry was reported in 18 studies. Achalasia (49.2%) was the most commonly associated motility disorder. Laparoscopic (61.9%), thoracoscopic (30.6%), or combined (6.7%) minimally invasive approaches were described. Adjunctive procedures were esophagomyotomy (87%) and Dor (34.6%) or Toupet (17.7%) fundoplication. The estimated pooled prevalence of staple-line leak was 9.8% (95% CrI 7.1-13.4%; I2 = 0.0). Exploratory unadjusted subgroup analyses did not identify statistically supported differences in staple-line leak according to myotomy (RR = 0.67; 95% CrI 0.17-3.52) or surgical approach (RR = 0.72; 95% CrI 0.22-3.39). The estimated pooled prevalence of overall complications, in-hospital mortality, and study-reported symptom resolution/improvement was 21.6% (95% CrI 16.1-28.4%), 1.3% (95% CrI 0.5-2.9%), and 92.1% (95% CrI 87.7-95%), respectively.
CONCLUSIONS: Current evidence reporting outcome for minimally invasive midesophageal and epiphrenic diverticulectomy is limited by study design and treatment heterogeneity. Future well-designed multicenter studies are required to assess the effect of surgical approach and esophageal myotomy on short-term morbidity, symptomatic outcomes, and recurrence rate.