Turkyilmaz A, Eroglu A, Aydin Y, Tekinbas C, Muharrem Erol M, Karaoglanoglu N
Department of Thoracic Surgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
Dis Esophagus. 2009;22(2):119-26. doi: 10.1111/j.1442-2050.2008.00866.x. Epub 2008 Oct 1.
Esophagogastric anastomotic leaks are the most feared surgical complications following resection of esophageal cancers. We aimed to develop a therapeutic algorithm for this complication characterized by high morbidity and mortality using our 20 years of experience and the published literature. A total of 354 patients who had undergone an esophagectomy and esophagogastric anastomosis due to esophageal carcinoma were evaluated retrospectively. The incidence for anastomotic leak was 15.5% (n = 90) in the cervical region and 4.2% (n = 264) in the thoracic region (mean: 7.1%). Cervical anastomotic leaks were detected after a mean period of 7.2 days following the procedure. Fourteen patients with cervical leaks were treated conservatively. Four out of 14 patients (28.6%) died due to sepsis and multi-organ failure related to fistula. Thoracic anastomotic leaks were detected after a mean period of 4.7 days following the procedure. Emergency reoperation, resection and reconstruction procedures were performed in one patient. Self-expanding metallic coated stents were placed at the anastomosis region in two patients. A more conservative approach was employed in other patients with thoracic anastomotic leaks. Six of them (46.2%) died due to fistula. General mortality rate was 37.0%, and the duration of hospitalization was 40.0 days for patients with anastomotic leaks. Cervical anastomotic leaks are more common than thoracic anastomotic leaks, but most of them are successfully treated with conservative approaches. Thoracic anastomotic leaks that in the past were related to high mortality rates despite conservative or surgical procedures might be successfully treated nowadays with the use of self-expanding metallic coated stents.
食管胃吻合口漏是食管癌切除术后最令人担忧的手术并发症。我们旨在利用我们20年的经验和已发表的文献，为这种具有高发病率和死亡率的并发症制定一种治疗方案。对354例因食管癌接受食管切除术和食管胃吻合术的患者进行了回顾性评估。吻合口漏的发生率在颈部为15.5%（n = 90），在胸部为4.2%（n = 264）（平均：7.1%）。颈部吻合口漏在术后平均7.2天被发现。14例颈部漏患者接受了保守治疗。14例患者中有4例（28.6%）因与瘘相关的败血症和多器官衰竭死亡。胸部吻合口漏在术后平均4.7天被发现。1例患者进行了急诊再次手术、切除和重建手术。2例患者在吻合口区域放置了自膨式金属覆膜支架。其他胸部吻合口漏患者采用了更保守的方法。其中6例（46.2%）因瘘死亡。吻合口漏患者的总死亡率为37.0%，住院时间为40.0天。颈部吻合口漏比胸部吻合口漏更常见，但大多数通过保守方法成功治疗。过去，尽管采用保守或手术方法，胸部吻合口漏的死亡率仍很高，如今使用自膨式金属覆膜支架可能成功治疗。
