Aurello Paolo, Magistri Paolo, D'Angelo Francesco, Valabrega Stefano, Sirimarco Dario, Tierno Simone Maria, Nava Andrea Kazemi, Ramacciato Giovanni
Department of General Surgery, Sant'Andrea Hospital, Sapienza-Università di Roma, Rome, Italy.
Am Surg. 2015 May;81(5):450-3.
Esophagojejunal anastomosis leakage is one of the major complications after total gastrectomy for gastric cancer and is an independent predictor of survival. Our aim is to systematically review the literature and discuss the reported therapeutic approaches to identify the best therapeutic approach. Pubmed, EMbase, Cochrane Library, CILEA Archive, BMJ Clinical Evidence, and Up ToDate databases were screened limiting the research to articles written in English from January 1992 through December 2013. This way a total of 474 manuscripts were retrieved for furthermore evaluation. Eleven manuscripts were considered eligible and the study is focused on those works. We analyzed a total of 3,893 patients and 114 cases of esophagojejunal anastomosis leakage. Different treatments were grouped into three main categories: conservative approach (66 cases), endoscopic approach (21 cases), and surgical approach (27 cases). The overall mortality rate is 26.32 per cent and surgical approach showed the higher rate. According to the reported data, a complete resolution of the leakage can be achieved in an interval ranging from 7 to 28 days in the group treated conservatively. Conservative approach should always be considered as the treatment of choice. Reoperation may be necessary in case of wide dehiscence or when other treatments fail; therefore, the high mortality rate related to this procedure is due to the comorbidities of patients undergoing relaparotomy. Finally, endoscopic approach with endoclips seems promising but needs furthermore studies.
食管空肠吻合口漏是胃癌全胃切除术后的主要并发症之一，也是生存的独立预测因素。我们的目的是系统回顾文献并讨论已报道的治疗方法，以确定最佳治疗方法。检索了PubMed、EMbase、Cochrane图书馆、CILEA存档、BMJ临床证据和UpToDate数据库，将研究限制在1992年1月至2013年12月期间撰写的英文文章。通过这种方式，共检索到474篇手稿以供进一步评估。11篇手稿被认为符合条件，本研究聚焦于这些文献。我们总共分析了3893例患者和114例食管空肠吻合口漏病例。不同的治疗方法分为三大类：保守治疗（66例）、内镜治疗（21例）和手术治疗（27例）。总死亡率为26.32%，手术治疗的死亡率较高。根据报道的数据，保守治疗组在7至28天的时间内可实现漏口的完全愈合。保守治疗应始终被视为首选治疗方法。在吻合口广泛裂开或其他治疗失败的情况下可能需要再次手术；因此，与该手术相关的高死亡率是由于再次剖腹手术患者的合并症所致。最后，使用内镜夹的内镜治疗似乎很有前景，但需要进一步研究。
