Facy Olivier, Goergen Martine, Poulain Virginie, Heieck Frank, Lens Vincent, Azagra Juan-Santiago
*Unité des Maladies de l'Appareil Digestif et Endocrine (UMADE) †Department of Radiology, Centre Hospitalier de Luxembourg, Luxembourg, UK.
Surg Laparosc Endosc Percutan Tech. 2014 Apr;24(2):183-6. doi: 10.1097/SLE.0b013e31828f6cc5.
Postoperative esophagojejunal fistula induces morbidity and mortality after total gastrectomy and affects the long-term survival rate.
Between 2003 and 2011, 38 patients underwent laparoscopic total gastrectomy and 2 developed an esophagojejunal fistula.
The diagnosis was established by a computed tomography scan with contrast ingestion. The absence of complete dehiscence and the vitality of the alimentary loop were checked during laparoscopic exploration, associated with effective drainage. During the endoscopy, dehiscence was assessed and a covered stent and nasojejunal tube were inserted for enteral feeding. The leaks healed progressively, oral feeding was resumed and the drains removed within 3 weeks. The stent was removed 6 weeks. Three months later, the patients were able to eat without dysphagia.
Early diagnosis allows successful conservative management. The objectives are effective drainage, covering by an endoscopic stent and renutrition. Management by a multidisciplinary team is essential.
全胃切除术后食管空肠瘘会导致发病和死亡，并影响长期生存率。
2003年至2011年间，38例患者接受了腹腔镜全胃切除术，其中2例发生了食管空肠瘘。
通过口服造影剂的计算机断层扫描确诊。在腹腔镜探查期间检查有无完全裂开及消化道袢的活力，并进行有效引流。在内镜检查时，评估裂开情况，并插入覆膜支架和鼻空肠管进行肠内喂养。瘘口逐渐愈合，3周内恢复经口进食并拔除引流管。6周后取出支架。3个月后，患者能够正常进食且无吞咽困难。
早期诊断可实现成功的保守治疗。目标是有效引流、内镜支架覆盖和重新营养支持。多学科团队管理至关重要。
