Guo Juntang, Chu Xiangyang, Liu Yang, Zhou Naikang, Ma Yongfu, Liang Chaoyang
Department of Thoracic Surgery, PLA General Hospital, 28# Fuxing Street, Beijing, China.
World J Surg Oncol. 2014 Dec 29;12:402. doi: 10.1186/1477-7819-12-402.
The aim of this study was to analyze our experience with management of intrathoracic anastomotic leak after esophagectomy.
Clinical data from 33 patients who developed intrathoracic anastomotic leak were evaluated retrospectively. These patients were selected from 1867 patients undergoing resection carcinoma of the esophagus and reconstruction between January 2003 and December 2012.
Surgical intervention and the reformed "three-tube method" were applied in 13 and 20 patients, respectively. The overall incidence of intrathoracic anastomotic leakage was 1.8%. The median time interval from esophagectomy to diagnosis of leak was 9.7 days. Sixteen patients were confirmed as having leakage by oral contrast computed tomography (CT). Age and interval from surgery to diagnosis of leak were identified as statistically significant parameters between contained and uncontained groups. Moreover, patients with hypoalbuminemia had a longer time to leak closure than patients without hypoalbuminemia. Six patients died from intrathoracic anastomotic leak, with a mortality rate of 18.2%. There was no statistically significant difference in the time to leak closure between patients who underwent surgical exploration and those who received conservative treatment.
Intrathoracic anastomotic leak after esophagectomy was associated with significant mortality. Once intrathoracic anastomotic leakage following esophagectomy was diagnosed or highly suspected, individualized management strategies should be implemented according to the size of the leak, extent of the abscess, and status of the patient. In the majority of patients with anastomotic leak, we preferred the strategy of conservative treatment.
本研究旨在分析我们在食管切除术后处理胸内吻合口漏方面的经验。
回顾性评估33例发生胸内吻合口漏患者的临床资料。这些患者选自2003年1月至2012年12月期间接受食管癌切除及重建手术的1867例患者。
分别对13例和20例患者实施了手术干预及改良的“三管法”。胸内吻合口漏的总体发生率为1.8%。从食管切除到诊断出漏的中位时间间隔为9.7天。16例患者经口服造影剂计算机断层扫描（CT）确诊为漏。年龄以及从手术到诊断出漏的时间间隔在局限性和非局限性组之间被确定为具有统计学意义的参数。此外，低蛋白血症患者的漏口闭合时间比无低蛋白血症患者更长。6例患者死于胸内吻合口漏，死亡率为18.2%。接受手术探查的患者与接受保守治疗的患者在漏口闭合时间上无统计学显著差异。
食管切除术后胸内吻合口漏与显著的死亡率相关。一旦诊断出或高度怀疑食管切除术后发生胸内吻合口漏，应根据漏口大小、脓肿范围及患者状况实施个体化的管理策略。对于大多数吻合口漏患者，我们更倾向于保守治疗策略。
