enucleation of tumor with fundoplication. In the early postoperative period, the lower thoracic esophageal perforation after videothoracoscopic enucleation of the tumor occurred in 2 cases, and it required video-assisted laparoscopic and posteriotransmediastenal drainage and video-assisted Maidl jejunonostomy. In one case, after 7 months after surgery scar stenosis of the lower third of the esophagus developed, which is eliminated by orthograde bougienage of the esophagus.
ВведениеОперативное лечение доброкачественных забо-леваний и повреждений пищевода преимущест-венно производится из традиционных хирургиче-ских доступов (торако-и лапаротомии) и характе-ризуется высокой травматичностью. Применение А.Ф. Черноусовым [9] трансхиатальной экстирпа-ции пищевода через лапароцервикальный доступ существенно снижает операционную травму. Из-за топографоанатомического расположения пищево-да, создающего существенные трудности для опера-тивных вмешательств на его грудном отделе, мини-инвазивные видеоэндохирургические технологии в основном используются на абдоминальном отделе пищевода при ахалазии кардии [1,3,4,[10][11][12][13]. Имеются лишь отдельные сообщения о видеотора-коскопических операциях для удаления рубцово-измененного пищевода [5,6], дивертикулов его грудного отдела [2], лейомиомы пищевода при тора-ко-или лапароскопии в зависимости от ее локали-зации [7,8]. Учитывая малую травматичность видео-эндохирургических вмешательств, более раннюю реабилитацию и улучшение качества жизни опери-
Relevance. Paraesophageal hiatal hernias are much less common than other types of diaphragmatic hernias. The risk of strangulation in this pathology is about 21 %. It is often very difficult to establish the correct diagnosis in time, because patients are admitted with an atypical clinic of acute cardiological or pulmonary pathology. Usually, the correct diagnosis is established only on the 4th day. Due to late diagnosis, necrosis and perforation of the strangulated organ occur, which causes high mortality; sometimes the correct diagnosis is established only at autopsy.Clinical observation. The patient was admitted to the surgical department on an emergency basis with complaints of intense pain in the lower chest and epigastric region, vomiting of eaten food. From the anamnesis it is known that about a year ago, periodic nausea and vomiting of food eaten began to bother. The last 12 hours before admission to the hospital, pain in the chest and epigastrium intensified, all eaten food came out with vomiting. X-ray diagnosed strangulated paraesophageal hernia of the esophageal opening of the diaphragm. During esophagogastroduodenoscopy it was impossible to pass into the distal parts of the stomach; hyperemia and petechial hemorrhages were detected in the zone of strangulation. Video-laparoscopic reduction of the hernial contents, resection of the hernial sac and anterior diaphragm crurorrhaphy were urgently performed. The early postoperative period was uneventful. The presented clinical observation indicates the promise of using video-endoscopic technologies for diagnosis and treatment of strangulated diaphragmatic hernias. The key to success is the timely establishment of the correct diagnosis. We consider it impractical to perform an antireflux intervention simultaneously in conditions of an acute inflammatory process.
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