Langer Felix B, Wenzl Etienne, Prager Gerhard, Salat Andreas, Miholic Johannes, Mang Thomas, Zacherl Johannes
Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria.
Ann Thorac Surg. 2005 Feb;79(2):398-403; discussion 404. doi: 10.1016/j.athoracsur.2004.07.006.
Esophageal anastomotic leaks can lead to prolonged hospitalization. In this article we present our experience with the placement of the Polyflex self-expanding plastic stent (Willy Ruesch GMBH, Kernen, Germany) for leak occlusion.
Between April 2000 and November 2003, 24 patients were included into this prospective study and underwent Polyflex stent placement for postoperative esophageal anastomotic leaks. The primary operation was esophagectomy in 13 patients, gastrectomy in 7, cardia resection in 2, and other procedures in 2 patients. The median interval between operation and stent placement was 19 days (range, 4 to 65). The effectiveness of leak occlusion was evaluated by water-soluble contrast swallow and the clinical course.
In 2 patients stent misplacement produced an enlarged anastomotic dehiscence that necessitated reoperation. Radiologic evaluation was impossible in 4 patients because of their generally restricted condition. Among 18 evaluable patients, leak occlusion was successful with a single stent in 16 patients (89%) based on radiologic evaluation. Immediate oral feeding was well tolerated by these patients. After a median follow-up of 220 days (range, 7 to 1221), 9 cases of late stent dislocation were observed. Stent removal in patients after esophagectomy with gastric pull-up led to dysphagia from anastomotic strictures in 2 patients. Symptomatic strictures did not develop in the 5 evaluable postgastrectomy patients after stent removal.
The placement of self-expanding plastic stents is a highly effective treatment for esophageal anastomotic leaks. Because clinically-relevant anastomotic strictures can be expected, we do not recommend stent removal after esophagectomy with gastric pull-up reconstruction.
食管吻合口漏可导致住院时间延长。在本文中，我们介绍了使用Polyflex自膨式塑料支架（德国克嫩市威利·吕施有限公司）封堵吻合口漏的经验。
2000年4月至2003年11月，24例患者纳入本前瞻性研究，接受Polyflex支架置入术治疗术后食管吻合口漏。初次手术为食管切除术13例，胃切除术7例，贲门切除术2例，其他手术2例。手术与支架置入的中位间隔时间为19天（范围4至65天）。通过水溶性造影剂吞咽检查和临床病程评估漏口封堵的有效性。
2例患者支架置入不当导致吻合口裂开扩大，需再次手术。4例患者因全身状况受限无法进行影像学评估。在18例可评估患者中，根据影像学评估，16例（89%）患者使用单个支架成功封堵漏口。这些患者能很好地耐受立即经口进食。中位随访220天（范围7至1221天）后，观察到9例晚期支架移位。食管切除胃上提术后患者取出支架导致2例患者因吻合口狭窄出现吞咽困难。5例可评估的胃切除术后患者取出支架后未出现有症状的狭窄。
自膨式塑料支架置入是治疗食管吻合口漏的高效方法。由于预计会出现临床相关的吻合口狭窄，我们不建议在食管切除胃上提重建术后取出支架。
