Kim Yu Jin, Shin Sung Kwan, Lee Hyun Jung, Chung Hyun Soo, Lee Yong Chan, Park Jun Chul, Hyung Woo Jin, Noh Sung Hoon, Kim Choong Bae, Lee Sang Kil
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
Scand J Gastroenterol. 2013 Jan;48(1):111-8. doi: 10.3109/00365521.2012.737362. Epub 2012 Nov 1.
Anastomotic leak is a dreadful complication with a high mortality rate. The authors aimed to evaluate the efficacy of endoscopic closure of anastomotic dehiscence after gastrectomy in patients with gastric cancer.
The authors retrospectively reviewed 33 patients with anastomotic leakage who had underdone endoscopic treatment among 5249 patients with gastric cancer who underwent radical total or subtotal gastrectomy. Methods of endoscopic closure included clipping with or without detachable snare, fibrosealant, Histoacryl® or stent insertion. Results of endoscopic treatment were categorized as complete, partial closure and failure.
The size of the tissue defect was the only factor that had statistically significant differences among the cases with complete closure, partial closure and failure (p = 0.005). For tissue defects smaller than 2 cm in size, complete closure was achieved in 19 (73.1%), partial closure in 5 patients (19.2%) and 2 failed (7.6%). For those larger than 2 cm in size, one (14.3%) was completely closed, four (57.1%) were partially closed and two (28.6%) failed.
Endoscopic treatment for anastomotic dehiscence smaller than 2 cm in size had excellent success rate in this study.
吻合口漏是一种可怕的并发症，死亡率很高。作者旨在评估内镜下闭合胃癌患者胃切除术后吻合口裂开的疗效。
作者回顾性分析了5249例行根治性全胃或次全胃切除术的胃癌患者中33例接受内镜治疗的吻合口漏患者。内镜闭合方法包括使用或不使用可分离圈套器夹闭、纤维蛋白胶、组织黏合剂或置入支架。内镜治疗结果分为完全闭合、部分闭合和失败。
组织缺损大小是完全闭合、部分闭合和失败病例中唯一具有统计学显著差异的因素（p = 0.005）。对于组织缺损小于2 cm的患者，19例（73.1%）实现完全闭合，5例（19.2%）部分闭合，2例（7.6%）失败。对于组织缺损大于2 cm的患者，1例（14.3%）完全闭合，4例（57.1%）部分闭合，2例（28.6%）失败。
在本研究中，内镜治疗小于2 cm的吻合口裂开成功率很高。
