食管癌切除术后胸内吻合口漏的意义的批判性评估。

Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer.

作者信息

Whooley B P, Law S, Alexandrou A, Murthy S C, Wong J

机构信息

Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, People's Republic of China.

出版信息

Am J Surg. 2001 Mar;181(3):198-203. doi: 10.1016/s0002-9610(01)00559-1.

DOI:10.1016/s0002-9610(01)00559-1

PMID:11376570

Abstract

BACKGROUND

Leakage from esophageal anastomoses is higher than that for other gastrointestinal anastomoses. An intrathoracic anastomotic leak is a potentially catastrophic event.

METHODS

Patients with and without thoracic anastomotic leakage were compared for predisposing factors. Leak-related mortality was analyzed.

RESULTS

Of 475 patients, there were 17 leaks (3.5%). Predisposing technical factors occurred significantly more frequently in patients who leaked. Sixteen such events were identified as contributory in 11 patients. The hospital mortality for patients who leaked was significantly higher (35% versus 9%, P = 0.005). Inadequate drainage and persistent sepsis accounted for 4 of the 6 deaths. The need for inotropic support postoperatively correlated with leak-related mortality (66% versus 0%, P = 0.006), while leak size, time to diagnosis, or method of drainage did not.

CONCLUSIONS

Thoracic anastomotic leaks are largely preventable. Leak-related mortality for the series was 1% and was most commonly related to inadequate drainage.

摘要

背景

食管吻合口漏的发生率高于其他胃肠道吻合口。胸内吻合口漏是一种潜在的灾难性事件。

方法

比较有和没有胸内吻合口漏的患者的易感因素。分析与漏相关的死亡率。

结果

475例患者中，有17例发生漏（3.5%）。易感技术因素在发生漏的患者中出现的频率显著更高。在11例患者中确定有16个此类事件有促成作用。发生漏的患者的医院死亡率显著更高（35%对9%，P = 0.005）。6例死亡中有4例是由于引流不足和持续脓毒症。术后需要使用正性肌力药物支持与漏相关的死亡率相关（66%对0%，P = 0.006），而漏的大小、诊断时间或引流方法则无关。