Lee Seohyun, Ahn Ji Yong, Jung Hwoon-Yong, Lee Jeong Hoon, Choi Kwi-Sook, Kim Do Hoon, Choi Kee Don, Song Ho June, Lee Gin Hyug, Kim Jin-Ho, Kim Beom Su, Yook Jeong Hwan, Oh Sung Tae, Kim Byung Sik, Han Seungbong
Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, No. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea,
Surg Endosc. 2013 Nov;27(11):4232-40. doi: 10.1007/s00464-013-3028-y. Epub 2013 Jun 20.
The purpose of this study was to evaluate the safety and efficacy of endoscopic therapy, an alternative and less invasive modality for the management of leakage after gastrectomy.
An electronic database of 35 patients with anastomotic leaks after surgery for stomach cancer that were treated with either an endoscopic procedure or surgery between January 2004 and March 2012 was reviewed. The success rates and safety of both modalities were evaluated.
Endoscopic treatment was performed in 20 patients and surgical treatment in 15 patients. The median time interval between the primary surgery and diagnosis of leakage was 8.0 days (interquartile range, 5.0-14.0 days). Of the 20 patients with endoscopic treatment, technical success was achieved in 19 patients (95 %) with resulting clinical success achieved in all of these 19 patients (100 %). One patient with failed endoscopic management went on to receive surgery. There were no cases of leakage-related deaths after endoscopic treatment. Of the 15 patients with surgical treatment, 5 died due to sepsis, bleeding, or hospital-acquired pneumonia. For diagnosis of leakage, 17 patients from the endoscopy group underwent computed tomography (CT) scanning, which revealed leakages in 3 patients (17.6 %) and occult leakages were subsequently defined at fluoroscopy in all 20 patients. Seven of twelve patients (58.3 %) from the surgical group had leakages diagnosed by CT scan.
Endoscopic treatment can be considered a valuable option for the management of postoperative anastomotic leakage with a high degree of technical feasibility and safety, particularly for leakages that are not excessively large.
本研究旨在评估内镜治疗的安全性和有效性，内镜治疗是一种用于胃切除术后漏出处理的替代性且侵入性较小的方式。
回顾了一个电子数据库，其中包含2004年1月至2012年3月期间因胃癌手术出现吻合口漏且接受了内镜手术或外科手术治疗的35例患者。评估了两种治疗方式的成功率和安全性。
20例患者接受了内镜治疗，15例患者接受了外科治疗。初次手术与漏出诊断之间的中位时间间隔为8.0天（四分位间距，5.0 - 14.0天）。在接受内镜治疗的20例患者中，19例（95%）取得了技术成功，这19例患者均取得了临床成功（100%）。1例内镜治疗失败的患者随后接受了手术。内镜治疗后没有与漏出相关的死亡病例。在接受外科治疗的15例患者中，5例因败血症、出血或医院获得性肺炎死亡。对于漏出的诊断，内镜组的17例患者接受了计算机断层扫描（CT），其中3例（17.6%）显示有漏出，随后所有20例患者经荧光透视确定有隐匿性漏出。外科组12例患者中的7例（58.3%）通过CT扫描诊断出有漏出。
内镜治疗可被视为处理术后吻合口漏的一种有价值的选择，具有高度的技术可行性和安全性，特别是对于漏出量不过大的情况。
