Tuebergen Dirk, Rijcken Emile, Mennigen Rudolf, Hopkins Ann M, Senninger Norbert, Bruewer Matthias
Department of General Surgery, Unit of Surgical Endoscopy, University of Muenster, Muenster, Germany.
J Gastrointest Surg. 2008 Jul;12(7):1168-76. doi: 10.1007/s11605-008-0500-4. Epub 2008 Mar 4.
Intra-thoracic esophageal leakage after esophageal resection or esophageal perforation is a life-threatening event. The objective of this non-randomized observational study was to evaluate the effects of endoluminal stent treatment in patients with esophageal anastomotic leakages or perforations in a single tertiary care center.
Thirty-two consecutive patients with an intrathoracic esophageal leak, caused by esophagectomy (n = 19), transhiatal gastrectomy (n = 3), laparoscopic fundoplication (n = 2), and iatrogenic or spontaneous perforation (n = 8), undergoing endoscopic stent treatment were evaluated. Hospital stay, mortality and morbidity, sealing rate, extraction rates, complications, and long-term effects were measured.
Median time interval between diagnosis and stent treatment was 3 and 5 days, respectively. Eighteen patients had futile surgical closure of the defect before stenting, while in 14 patients, stent placement was the primary treatment for leakage. Stent placement was technically correct in all patients. Functional sealing was achieved in 78%. Mortality was 15.6%. Stent extraction rate was 70%. Overall method-related complications occurred in nine patients (28%).
Implantation of self-expanding stents after esophageal resection or perforation is a feasible and safe procedure with an acceptable morbidity even if used as last-choice treatment.
食管切除术后或食管穿孔后的胸段食管漏是一种危及生命的事件。这项非随机观察性研究的目的是评估在单一三级医疗中心对食管吻合口漏或穿孔患者进行腔内支架治疗的效果。
对32例连续性胸段食管漏患者进行评估，这些患者的食管漏由食管切除术（n = 19）、经裂孔胃切除术（n = 3）、腹腔镜胃底折叠术（n = 2）以及医源性或自发性穿孔（n = 8）引起，均接受了内镜支架治疗。测量住院时间、死亡率和发病率、封堵率、取出率、并发症以及长期效果。
诊断与支架治疗之间的中位时间间隔分别为3天和5天。18例患者在置入支架前进行了无效的手术修补缺损，而14例患者中，支架置入是漏口的主要治疗方法。所有患者的支架置入技术上均正确。78%实现了功能性封堵。死亡率为15.6%。支架取出率为70%。9例患者（28%）发生了总体与方法相关的并发症。
食管切除或穿孔后植入自膨式支架是一种可行且安全的手术，即使作为最后选择的治疗方法，发病率也可接受。
