Licht Eugene, Markowitz Arnold J, Bains Manjit S, Gerdes Hans, Ludwig Emmy, Mendelsohn Robin B, Rizk Nabil P, Shah Pari, Strong Vivian E, Schattner Mark A
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Ann Thorac Surg. 2016 Jan;101(1):301-4. doi: 10.1016/j.athoracsur.2015.06.072. Epub 2015 Sep 28.
Esophageal anastomotic leaks after cancer surgery remain a major cause of morbidity and mortality. Endoscopic interventions, including covered metal stents (cSEMS), clips, and direct percutaneous endoscopic jejunostomy (dPEJ) tubes are increasingly used despite limited published data regarding their utility in this setting. This study aimed to determine the efficacy and safety of a multimodality endoscopic approach to anastomotic leak management after operation for esophageal or gastric cancer.
We performed a retrospective review of prospectively maintained databases of gastric and esophageal operations at our hospital between January 2003 and December 2012. Included patients had an operation for esophageal or gastric cancer, demonstrated evidence of an anastomotic leak at the esophageal anastomosis, and underwent attempted endoscopic therapy. Healing was defined as clinical and radiographic leak resolution.
Forty-nine patients with leaks underwent endoscopic management. Of the 49 patients, 31 (63%) received cSEMS, 40 (82%) had dPEJ tubes inserted, and 3 (6%) received clips. Twenty-three (47%) patients underwent a combined approach. Overall, 88% of patients achieved healing in a median of 83 days. Twenty-two of 23 patients (96%) who underwent a multimodality endoscopic approach healed. Only 1 patient had a major complication associated with stent erosion into the pulmonary artery, which was successfully treated with operative repair.
Esophageal anastomotic leaks after esophageal and gastric cancer operations can be managed successfully and safely with endoscopic therapy. Combining cSEMS for leak control and dPEJ tube placement for nutritional support was highly effective in achieving healing, without the need for surgical repair.
癌症手术后食管吻合口漏仍然是发病和死亡的主要原因。尽管关于内镜干预（包括覆膜金属支架（cSEMS）、夹子和直接经皮内镜空肠造口术（dPEJ）管）在此情况下的效用的已发表数据有限，但它们的使用越来越广泛。本研究旨在确定多模式内镜方法治疗食管癌或胃癌手术后吻合口漏的有效性和安全性。
我们对2003年1月至2012年12月我院前瞻性维护的胃癌和食管癌手术数据库进行了回顾性研究。纳入的患者接受了食管癌或胃癌手术，食管吻合口有吻合口漏的证据，并接受了内镜治疗尝试。愈合定义为临床和影像学上漏口消失。
49例有漏口的患者接受了内镜治疗。在这49例患者中，31例（63%）接受了cSEMS，40例（82%）插入了dPEJ管，3例（6%）接受了夹子治疗。23例（47%）患者采用了联合治疗方法。总体而言，88%的患者在中位83天内实现愈合。采用多模式内镜方法的23例患者中有22例（96%）愈合。只有1例患者出现了与支架侵蚀肺动脉相关的严重并发症，经手术修复成功治疗。
食管癌和胃癌手术后的食管吻合口漏可以通过内镜治疗成功且安全地处理。联合使用cSEMS控制漏口和放置dPEJ管进行营养支持在实现愈合方面非常有效，无需手术修复。
