Urschel J D
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA.
Recent Results Cancer Res. 2000;155:135-44. doi: 10.1007/978-3-642-59600-1_14.
The etiology of esophagogastric anastomotic leaks is often multifactorial. However, occult ischemia of the gastric fundus is an important cause. In gastric conditioning, preliminary partial gastric devascularization is carried out 2-3 weeks before construction of the esophagogastric anastomoses. Gastric vascularity improves over this time. In animal studies, gastric conditioning has reduced the incidence of anastomotic leaks. Clinically, the concept of gastric conditioning can be used in several ways. Esophagectomy can be done at one stage, then a cervical esophagogastric anastomosis can be completed as a second-stage procedure. Pre-esophagectomy angiographic gastric artery embolization is another method of gastric conditioning. Finally, laparoscopic partial gastric devascularization can be done at the time of laparoscopic cancer staging. For gastric conditioning to be clinically useful, the benefit from reduction in leaks must be greater than the costs and morbidity of the conditioning procedure itself.
食管胃吻合口漏的病因通常是多因素的。然而，胃底隐匿性缺血是一个重要原因。在胃预处理中，在食管胃吻合术构建前2 - 3周进行初步的部分胃去血管化。在此期间胃血管情况会改善。在动物研究中，胃预处理降低了吻合口漏的发生率。临床上，胃预处理的概念有多种应用方式。可以一期进行食管切除术，然后二期完成颈部食管胃吻合术。术前食管造影胃动脉栓塞是胃预处理的另一种方法。最后，在腹腔镜癌症分期时可进行腹腔镜部分胃去血管化。为使胃预处理在临床上有用，减少漏的益处必须大于预处理本身的成本和发病率。
