Experimental study on surgical influences of the phasic difference of thoracotomy from laparotomy: with special emphasis on the kinetics of the pulmonary water content
Tsuno, Y.
Nihon Kyobu Geka Gakkai 37(12): 2439-2448
1989
ISSN/ISBN: 0369-4739 PMID: 2625555 Document Number: 334704
Radical operation for patients with thoracic esophageal cancer is one of the surgical procedures with the most severe surgical stress in the digestive system because of frequent serious postoperative complications particularly with respiratory problems. For the purpose of reducing surgical influences and postoperative pulmonary complications in patients with esophageal cancer, we have been insisting on "one-stage operation" with preceding reconstruction of the esophagus on the basis of our clinical experiences and model experiments. In the model experiments mimicking radical operation for thoracic esophageal cancer, the increase of intra-operative and post-operative pulmonary water content in the laparotomy-preceding group (LPG) is lesser than in the thoracotomy-preceding group (TPG). This results were also supported by histological findings. In the TPG, a tendency of pulmonary water accumulation was accelerated with an increase of surgical influences and, in addition, pulmonary water accumulation was noted even in the lung of the opposite side. Furthermore, the host defense reaction to the surgery and the influences of respiratory and circulatory systems were observed predominantly in this group. It is concluded that one-stage operation with preceding reconstruction of the esophagus shows a rationality in reducing the the surgical influences to the body, especially to the pulmonary systems.