Schorsch T, Müller C, Loske G
Klinik für Allgemein-, Viszeral-, Thorax-, und Gefäßchirurgie, Katholisches Marienkrankenhaus, GmbH, Alfredstr. 9, 22087, Hamburg, Deutschland.
Chirurg. 2014 Dec;85(12):1081-93. doi: 10.1007/s00104-014-2764-4.
The high morbidity and mortality of esophageal defects show that the clinical challenge in the treatment of this disease still remains. An innovative method which has been developed in recent years for esophageal leakage is endoscopic vacuum therapy.
A retrospective analysis of all patients treated for esophageal perforation with endoscopic vacuum therapy in our department was carried out.
From November 2006 to October 2013 a total of 35 patients were treated with this method and of these 21 had anastomotic leakage, 7 had iatrogenic perforation due to flexible or rigid endoscopy and 7 patients had esophageal defects of various other origins. Drainage systems with an open pore polyurethane tip were placed using a standard endoscope. The vacuum drainage may be positioned either in the esophageal lumen onto the defect or through the defect into the extraluminal wound cavity. The intraluminal or intracavitary vacuum drainage is connected to an electronically controlled vacuum device and a continuous negative pressure of 125 mmHg is maintained for several days. The esophageal lumen or wound cavity collapses around the drainage resulting in intraluminal evacuation and closure of the defect. Under endoscopic monitoring the vacuum system is changed regularly until stable secondary healing of the intracorporeal wound or closure of the transmural defect is achieved.
In 32 out of 35 patients (91.4 %) healing of defects was achieved after median treatment duration of 11 days (range 4-78 days). The postoperative anastomotic leakage healed in 20 out of 21 patients (95.2 %) after a median of 11 days (range 4-46 days) of therapy. The defects in the 7 patients who were treated for iatrogenic perforation all healed (100 %) after a median treatment time of 5 days (range 4-7 days). There was one case of a recurrent fistula 75 days after treatment. The 90-day mortality in this series of 35 patients was 5.7 %.
The results of this retrospective study emphasize the increasing importance of endoscopic vacuum therapy in the current literature as an endoscopic treatment method in the management of esophageal perforation and anastomotic leakage.
食管缺损的高发病率和高死亡率表明，该病治疗中的临床挑战依然存在。近年来开发的一种用于治疗食管漏的创新方法是内镜下真空治疗。
对我科采用内镜下真空治疗的所有食管穿孔患者进行回顾性分析。
2006年11月至2013年10月，共有35例患者接受了该方法治疗，其中21例为吻合口漏，7例因软性或硬性内镜检查导致医源性穿孔，7例患者有其他各种原因引起的食管缺损。使用标准内镜放置带有开孔聚氨酯尖端的引流系统。真空引流可置于食管腔内的缺损处，或通过缺损进入腔外伤口腔。腔内或腔内真空引流连接到电子控制的真空装置，并维持125 mmHg的持续负压数天。食管腔或伤口腔在引流周围塌陷，导致腔内排空和缺损闭合。在内镜监测下，定期更换真空系统，直到体内伤口稳定二期愈合或经壁缺损闭合。
35例患者中有32例（91.4%）在中位治疗时间11天（范围4 - 78天）后缺损愈合。21例术后吻合口漏患者中有20例（95.2%）在中位治疗11天（范围4 - 46天）后愈合。7例因医源性穿孔接受治疗的患者的缺损在中位治疗时间5天（范围4 - 7天）后全部愈合（100%）。治疗75天后有1例复发性瘘管病例。这35例患者的90天死亡率为5.7%。
这项回顾性研究的结果强调了内镜下真空治疗作为一种内镜治疗方法在食管穿孔和吻合口漏管理中的重要性在当前文献中日益增加。
