Schweigert Michael, Dubecz Attila, Stadlhuber Rudolf J, Muschweck Herbert, Stein Hubert J
Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany.
Interact Cardiovasc Thorac Surg. 2011 Feb;12(2):147-51. doi: 10.1510/icvts.2010.247866. Epub 2010 Nov 23.
Intrathoracic anastomotic leakage in patients with esophagectomy is associated with high morbidity and mortality. Until recently surgical reexploration was the preferred way of dealing with this life-threatening complication. But mortality remained significant. After the first successful reports we adopted endoscopic stent implantation as a primary treatment option. The aim of this study was to investigate the feasibility and the results of endoscopic stent implantation. Between January 2004 and December 2009, 167 patients underwent an esophageal resection. Surgery was mainly the result of esophageal cancer. An intrathoracic esophageal anastomotic leak was endoscopically verified in 17 patients. Twelve patients received an implantation of a self-expanding stent as a primary treatment. An endoscopic stent placement was accomplished in all 12 patients. In nine patients a definitive closure of the leak was achieved and the stent could subsequently be removed. Two patients died due to severe sepsis in spite of sufficient stent placement. Because of early recurrence of very malign small cell cancer the stent remained in situ in one patient. In conclusion, stent implantation for intrathoracic esophageal anastomotic leaks is feasible and compares favorable with the results of surgical reexploration. It is an easily available minimally-invasive procedure which may reduce leak-related mortality and morbidity.
食管切除术后患者的胸内吻合口漏与高发病率和死亡率相关。直到最近，手术再次探查仍是处理这种危及生命并发症的首选方法。但死亡率仍然很高。在首批成功报告之后，我们采用内镜支架植入作为主要治疗选择。本研究的目的是探讨内镜支架植入的可行性和结果。2004年1月至2009年12月期间，167例患者接受了食管切除术。手术主要是食管癌所致。17例患者经内镜证实存在胸段食管吻合口漏。12例患者接受自膨式支架植入作为主要治疗。12例患者均完成了内镜支架置入。9例患者漏口得到确定性闭合，随后支架可以取出。2例患者尽管支架置入充分，但因严重脓毒症死亡。1例患者因极恶性小细胞癌早期复发，支架仍留在原位。总之，胸段食管吻合口漏的支架植入是可行的，与手术再次探查的结果相比具有优势。它是一种易于实施的微创手术，可降低与漏相关的死亡率和发病率。
