Transposição cervical de tubo gástrico na reconstrução digestiva após esofagectomia por cancro do esófago – detalhes técnicos

  • Paulo Costa Professor Catedrático, Director de Serviço, FACS, FRCS (Eng), Clínica Universitária de Cirurgia I – Faculdade de Medicina da Universidade de Lisboa (FMUL) e Hospital de Santa Maria (CHLN)
  • Rui Esteves Assistente Hospitalar Graduado de Cirurgia Geral e Assistente da FMUL, Clínica Universitária de Cirurgia I – Faculdade de Medicina da Universidade de Lisboa (FMUL) e Hospital de Santa Maria (CHLN)
  • Patrícia Lages Assistente Hospitalar de Cirurgia Geral e Assistente da FMUL, Clínica Universitária de Cirurgia I – Faculdade de Medicina da Universidade de Lisboa (FMUL) e Hospital de Santa Maria (CHLN)
  • Filipa Ferreira Interna do Complementar de Cirurgia Geral, Clínica Universitária de Cirurgia I – Faculdade de Medicina da Universidade de Lisboa (FMUL) e Hospital de Santa Maria (CHLN)

Resumo

Introdução: A anastomose esofagogástrica cervical está associada a taxa elevada de deiscências (0-18%) e estenoses ( até 43%). O objectivo deste trabalho é analisar uma série consecutiva de doentes submetidos a esofagectomia, em que o tubo gástrico foi sistematicamente elaborado para minimizar estas complicações.

Material e Métodos: Estudo retrospectivo, incluindo os últimos 50 doentes consecutivos, com Carcinoma do esófago, 7 F e 43 M, idade média 63 [46-85] anos. Foram excluídos deste estudo os doentes sem cancro esofágico e as esofagocoloplastias. Na construção do tubo gástrico (n=50) e na sua mobilização para o tórax (n=3) ou para o pescoço (n=47) foi tido em atenção: manipulação mínima do estômago, preservação cuidada da vascularização, manobra de Kocher para que o piloro seja mobilizável até ao hiato, piloromiotomia, anastomose esofagogástrica término-lateral. A estabilidade hemodinâmica e ventilatória, intra e pós-operatórias, foram cuidadosamente asseguradas por monitorização contínua. Avaliação clínica e radiológica da continência e permeabilidade das anastomoses. Dilatação endoscópica das estenoses.

Resultados: 2 fístulas cervicais (clínicas) e 1 radiológica. Não se verificou nenhuma necrose da plastia. Os 11 doentes com estenose foram submetidos a dilatações endoscópicas. O tubo gástrico com operação de drenagem pilórica comportou-se como um bom método de assegurar a alimentação dos doentes esofagectomizados sem ter sido necessário nenhuma substituição do conduto.

Conclusão: Os detalhes técnicos da construção da plastia gástrica e a estabilidade peri-operatória são factores determinantes dos resultados conseguidos com esta técnica.

Palavras-chave: Tubo gástrico, transposição cervical gástrica, anastomose esofagogástrica cervical. 

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Como Citar
COSTA, Paulo et al. Transposição cervical de tubo gástrico na reconstrução digestiva após esofagectomia por cancro do esófago – detalhes técnicos. Revista Portuguesa de Cirurgia, [S.l.], n. 25, p. 9-21, jan. 2014. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/309>. Acesso em: 11 nov. 2019.
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