Lee Seohyun, Ahn Ji Yong, Jung Hwoon-Yong, Lee Jeong Hoon, Choi Kwi-Sook, Kim Do Hoon, Choi Kee Don, Song Ho June, Lee Gin Hyug, Kim Jin-Ho, Kim Beom Su, Yook Jeong Hwan, Oh Sung Tae, Kim Byung Sik
Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, No. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea.
Department of Surgery, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, Seoul, Korea.
Dig Dis Sci. 2016 Feb;61(2):523-32. doi: 10.1007/s10620-015-3880-9. Epub 2015 Nov 4.
BACKGROUND & AIM: We evaluated the clinical outcomes according to treatment modality for gastrointestinal anastomotic leakage.
Of the 19,207 patients who underwent gastrectomy for gastric cancer from March 2000 to April 2013, we retrospectively analyzed the 133 cases who developed anastomotic leakage. These patients were treated using endoscopic management, surgery, or conservative management (endoscopic treatment was introduced in 2009). To evaluate the efficacy of endoscopic treatment, we compared the clinical outcomes between the conservative management-only group before 2009 and the conservative or endoscopic management group from 2009; and between the surgical management-only group before 2009 and the surgical or endoscopic management group from 2009.
Seventy-three were initially managed conservatively, 35 were treated surgically, and 25 were treated using endoscopic procedures. Chronologically comparing each treatment group as 'before 2009' (n = 54) and 'from 2009' (n = 79), there were differences in the length of hospital stay (median 32 versus 27, p = 0.048) and duration of antibiotic use (median 28 versus 20, p = 0.013). Patients who underwent conservative or endoscopic management from 2009 showed a shorter hospital stay, period of fasting, and duration of antibiotic use than patients who underwent only conservative management before 2009. Patients who received surgery or endoscopic management from 2009 showed a shorter hospital stay and duration of antibiotic use than patients who underwent only surgery before 2009.
Endoscopic management for selected cases can reduce duration of hospital stay and antibiotic administration in the treatment of anastomotic leakage after gastrectomy.
我们根据胃肠道吻合口漏的治疗方式评估了临床结局。
在2000年3月至2013年4月期间接受胃癌胃切除术的19207例患者中，我们回顾性分析了发生吻合口漏的133例患者。这些患者采用内镜治疗、手术或保守治疗（内镜治疗于2009年引入）。为评估内镜治疗的疗效，我们比较了2009年前仅采用保守治疗的组与2009年起采用保守或内镜治疗的组之间的临床结局；以及2009年前仅采用手术治疗的组与2009年起采用手术或内镜治疗的组之间的临床结局。
73例最初采用保守治疗，35例接受手术治疗，25例采用内镜治疗。按时间顺序将每个治疗组分为“2009年前”（n = 54）和“2009年起”（n = 79），住院时间（中位数32天对27天，p = 0.048）和抗生素使用时间（中位数28天对20天，p = 0.013）存在差异。2009年起接受保守或内镜治疗的患者比2009年前仅接受保守治疗的患者住院时间、禁食期和抗生素使用时间更短。2009年起接受手术或内镜治疗的患者比2009年前仅接受手术治疗的患者住院时间和抗生素使用时间更短。
对于选定病例，内镜治疗可减少胃切除术后吻合口漏治疗中的住院时间和抗生素使用时间。
