机器人辅助带蒂自体心包补片联合背阔肌瓣修复食管-左主支气管瘘：cT4b食管癌放化疗后的新技术

Robotic repair of an esophago-left main bronchial fistula using a pedicled autologous pericardial patch and latissimus dorsi muscle flap: a novel technique after chemoradiotherapy for cT4b esophageal cancer.

期刊: Esophagus
PMID: 42663916
原文: PubMed ↗
发布日期: 2026-08-28

作者

Tomoki Makino — Department of Gastroenterological Surgery, The University of Osaka Graduate School of Medicine, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan. tmakino@gesurg.med.osaka-u.ac.jp.
Shigeto Nakai — Department of Gastroenterological Surgery, The University of Osaka Graduate School of Medicine, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
Tomohira Takeoka — Department of Gastroenterological Surgery, Sakai City Medical Center, Osaka, Japan.
Kotaro Yamashita — Department of Gastroenterological Surgery, The University of Osaka Graduate School of Medicine, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
Kazuya Kuroda — Department of Plastic Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.
Koji Tanaka — Department of Gastroenterological Surgery, The University of Osaka Graduate School of Medicine, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
Takashi Kanou — Department of General Thoracic Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.
Tateki Kubo — Department of Plastic Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.
Yasushi Shintani — Department of General Thoracic Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.
Shigeru Miyagawa — Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.
Hidetoshi Eguchi — Department of Gastroenterological Surgery, The University of Osaka Graduate School of Medicine, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
Yuichiro Doki — Department of Gastroenterological Surgery, The University of Osaka Graduate School of Medicine, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.

作者单位

Department of Gastroenterological Surgery, The University of Osaka Graduate School of Medicine, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan. tmakino@gesurg.med.osaka-u.ac.jp.
Department of Gastroenterological Surgery, The University of Osaka Graduate School of Medicine, 2-2-E2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
Department of Gastroenterological Surgery, Sakai City Medical Center, Osaka, Japan.
Department of Plastic Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.
Department of General Thoracic Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.
Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.

摘要

中文

一旦cT4b食管癌放化疗期间发生食管-气道瘘，进一步治愈性治疗常受阻。我们描述一种机器人技术，使用带蒂自体心包补片并用背阔肌瓣加强来关闭大的食管-左主支气管瘘。一名66岁女性，中上胸段食管鳞状细胞癌侵犯左主支气管，在根治性放化疗后出现瘘。经临时气道支架后，在半俯卧位、单肺通气和CO₂气胸下进行挽救性手术。胸腔镜食管切除术后，机器人制作马蹄形带蒂心包补片，向头侧翻转并缝合至支气管缺损。然后将右侧背阔肌瓣通过第二个肋间开口引入右胸腔，并在机器人辅助下固定在修复处。据我们所知，这是该机器人技术的首次报道。

English

Once an esophago-airway fistula develops during chemoradiotherapy for cT4b esophageal cancer, further curative treatment is often precluded. We describe a robotic technique for closure of a large esophago-left main bronchial fistula using a pedicled autologous pericardial patch reinforced with a latissimus dorsi muscle flap. A 66-year-old woman with squamous cell carcinoma of the middle to upper thoracic esophagus invading the left main bronchus developed a fistula after definitive chemoradiotherapy. After temporary airway stenting, salvage surgery was performed in the semi-prone position under single-lung ventilation and CO₂ pneumothorax. Following thoracic esophagectomy, a horseshoe-shaped pedicled pericardial patch was created robotically, flipped cranially, and sutured to the bronchial defect. A right latissimus dorsi muscle flap was then introduced into the right thoracic cavity through a second intercostal opening and robotically fixed over the repair. To our knowledge, this is the first report of this robotic technique.

分类与指标

研究类型: 临床研究
病种: 食管癌
JCR 分区: Q1
影响因子: 5.8
新锐分区: 4区