Schubert D, Dalicho St, Flohr L, Benedix F, Lippert H
Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Otto-von-Guericke-Universität Magdeburg, Deutschland.
Chirurg. 2012 Aug;83(8):712-8. doi: 10.1007/s00104-011-2265-7.
Complications following esophagectomy significantly affect the outcome, including perioperative mortality, costs and survival. Pulmonary complications and anastomotic leaks still remain the most serious complications and early recognition and appropriate initial treatment are essential. Mortality associated with esophageal leaks is decreasing due in part to the increased use of computed tomography (CT) scanning and endoscopy for diagnosis and subsequent appropriate multidisciplinary therapy. In this respect, it is critically important to differentiate between leaks and conduit necrosis, and endoscopic examination is the best method for making this assessment. Endoscopic and interventional radiology techniques are being applied increasingly for detection of intrathoracic leaks but appropriate patient selection is important. Adequate external drainage of the leak and prevention of further contamination are the primary therapeutic goals. The spectrum of therapeutic options ranges from simple conservative treatment for smaller, well drained leaks, interventional placement of drains, to endoscopic intervention with closure of the fistula or placement of stents and reoperation or discontinuity resection for conduit necrosis.
食管切除术后的并发症会显著影响治疗结果，包括围手术期死亡率、费用和生存率。肺部并发症和吻合口漏仍然是最严重的并发症，早期识别和适当的初始治疗至关重要。与食管漏相关的死亡率正在下降，部分原因是计算机断层扫描（CT）和内镜检查在诊断及后续适当的多学科治疗中的应用增加。在这方面，区分漏与管道坏死至关重要，而内镜检查是进行这种评估的最佳方法。内镜和介入放射学技术越来越多地用于检测胸内漏，但合适的患者选择很重要。漏的充分外部引流和防止进一步污染是主要治疗目标。治疗选择范围从针对较小、引流良好的漏的简单保守治疗、介入放置引流管，到内镜干预（瘘管闭合或支架置入）以及针对管道坏死的再次手术或间断切除。
