PDF(Pubmed)
Abstract：
BACKGROUND: Soft coagulation is a hemostatic system of electrosurgical units that automatically regulates its output to avoid carbonization or incision. This system is widely used in invasive procedures, including thoracic surgery. Few reports exist on the harmful effects of these devices. Herein, we encountered a case of an esophagopleural fistula caused by soft coagulation.
METHODS: A 74-year-old man with a history of bladder cancer was diagnosed with a tumor in the right lower lung lobe 2.5 cm in diameter. A thoracoscopic right lower lobectomy with lymph node dissection was performed. During surgery, hemostasis using soft coagulation was performed on the right wall of the lower esophagus. Eight days after surgery, thoracoscopic empyema curettage and drainage were performed. Three days after the second surgery, an esophageal fistula was identified. Suturing for the esophageal fistula and omentoplasty were performed. Suture failure occurred and an esophagobronchial fistula developed after the third surgery, which was reduced by drainage, antibiotics, and enteral nutrition. The fistula was finally addressed by fibrin glue filling in its cavity.
CONCLUSIONS: Soft coagulation helps manage hemostasis and contributes to safe surgery. However, it may cause severe complications owing to the unpredictable spread of heat denaturation. It is suspected that delayed esophageal perforation was caused by an unnoticed heat injury to the deeper layer of the esophageal wall.
CONCLUSIONS: There have been no reports of esophagus injury caused by soft coagulation exept for our experience. Although soft coagulation is a useful device owing to its excellent hemostatic capacity, the spread of heat denaturation may cause unpredictable tissue damage. Extra caution should be observed when using this device for hemostasis.
METHODS: A 74-year-old man with a history of bladder cancer was diagnosed with a tumor in the right lower lung lobe 2.5 cm in diameter. A thoracoscopic right lower lobectomy with lymph node dissection was performed. During surgery, hemostasis using soft coagulation was performed on the right wall of the lower esophagus. Eight days after surgery, thoracoscopic empyema curettage and drainage were performed. Three days after the second surgery, an esophageal fistula was identified. Suturing for the esophageal fistula and omentoplasty were performed. Suture failure occurred and an esophagobronchial fistula developed after the third surgery, which was reduced by drainage, antibiotics, and enteral nutrition. The fistula was finally addressed by fibrin glue filling in its cavity.
CONCLUSIONS: Soft coagulation helps manage hemostasis and contributes to safe surgery. However, it may cause severe complications owing to the unpredictable spread of heat denaturation. It is suspected that delayed esophageal perforation was caused by an unnoticed heat injury to the deeper layer of the esophageal wall.
CONCLUSIONS: There have been no reports of esophagus injury caused by soft coagulation exept for our experience. Although soft coagulation is a useful device owing to its excellent hemostatic capacity, the spread of heat denaturation may cause unpredictable tissue damage. Extra caution should be observed when using this device for hemostasis.
摘要：
背景：软凝固是电外科单元的止血系统，可自动调节其输出以避免碳化或切口。该系统广泛用于侵入性手术，包括胸外科手术.关于这些设备的有害影响的报道很少。在这里，我们遇到一例由软凝引起的食管胸膜瘘。
方法：一名74岁有膀胱癌病史的男性患者被诊断为右下肺叶直径2.5cm的肿瘤。行胸腔镜右下肺叶切除术伴淋巴结清扫术。手术期间,在食管下段右壁进行软凝止血.手术后八天,胸腔镜下脓胸刮除引流。第二次手术三天后,发现食管瘘.进行食管瘘缝合术和网膜成形术。第三次手术后出现缝合失败和食管支气管瘘，通过排水减少了，抗生素,和肠内营养。瘘管最终通过填充其腔中的纤维蛋白胶解决。
结论：软凝有助于止血并有助于手术安全。然而,由于不可预测的热变性扩散，它可能导致严重的并发症。怀疑延迟的食管穿孔是由于未被注意到的食管壁深层热损伤引起的。
结论：根据我们的经验，没有关于软凝治疗导致食道损伤的报道。虽然软凝固术由于其优异的止血能力是一种有用的装置，热变性的扩散可能导致不可预测的组织损伤。使用本装置止血时应格外小心。
方法：一名74岁有膀胱癌病史的男性患者被诊断为右下肺叶直径2.5cm的肿瘤。行胸腔镜右下肺叶切除术伴淋巴结清扫术。手术期间,在食管下段右壁进行软凝止血.手术后八天,胸腔镜下脓胸刮除引流。第二次手术三天后,发现食管瘘.进行食管瘘缝合术和网膜成形术。第三次手术后出现缝合失败和食管支气管瘘，通过排水减少了，抗生素,和肠内营养。瘘管最终通过填充其腔中的纤维蛋白胶解决。
结论：软凝有助于止血并有助于手术安全。然而,由于不可预测的热变性扩散，它可能导致严重的并发症。怀疑延迟的食管穿孔是由于未被注意到的食管壁深层热损伤引起的。
结论：根据我们的经验，没有关于软凝治疗导致食道损伤的报道。虽然软凝固术由于其优异的止血能力是一种有用的装置，热变性的扩散可能导致不可预测的组织损伤。使用本装置止血时应格外小心。
