Stašek M, Aujeský R, Vrba R, Chudáček J, Bébarová L, Gregořík M, Klos D, Neoral Č
Rozhl Chir. 2018 Spring;97(7):349-353.
Post-oesophagectomy leakage occurs in 1-30% of cases as a significant factor in postoperative morbidity and mortality, accounting for 40% of postoperative deaths. Endoscopic vacuum therapy (EVAC) is, besides stent therapy, clips and surgical therapy, a new endoscopic thera-peutic modality.
A 72-year-old polymorbid female patient with Siewert type II adenocarcinoma of the distal esophagus (T1b, N0, M0) was indicated for resection of the upper stomach and lower thoracic esophagus from laparotomy and thoracotomy with reconstruction using double-stapling anastomosis. On postoperative day 12, a 3rd degree leakage with propagation into the right pleural cavity was proven on CT. Endoscopy showed a defect affecting 30% of the circumference with a 7×3×3 cm cavity. Because of the leak morphology, EVAC was indicated. The therapy comprised 12 sessions with 3-4-day intervals for a total duration of 40 days with 5 extraluminal and 7 intraluminal applications and negative pressure of 100-125 mmHg. The condition was complicated by global respiratory failure due to severe pneumonia. Artificial ventilation was terminated on the 58th postoperative day. The patient was discharged to a rehabilitation facility on the 90th postoperative day. The follow-up 3 months after discharge confirms satisfactory performance results with full replenishment.
The therapy of complications of intrathoracic anastomoses after oesophagectomy has shown a trend toward reduced invasiveness and wider implementation of endoscopic methods. In spite of its shortcomings, the use of EVAC is a safe and highly effective therapeutic option even for extensive anastomotic defects. The future use, indications as well as relation to other therapeutic options require further evaluation. Key words: endoscopic vacuum therapy - esophageal leakage - esophagectomy complications - intraoperative endoscopy.
食管切除术后漏出在1%至30%的病例中发生，是术后发病和死亡的重要因素，占术后死亡的40%。除支架治疗、夹子和手术治疗外，内镜下真空治疗（EVAC）是一种新的内镜治疗方式。
一名72岁患有多种疾病的女性患者，患有食管远端Siewert II型腺癌（T1b，N0，M0），拟通过剖腹术和开胸术切除上胃和下胸段食管，并采用双吻合器吻合重建。术后第12天，CT证实为3度漏出并蔓延至右胸腔。内镜检查显示一个占圆周30%的缺损，有一个7×3×3 cm的腔隙。由于漏出的形态，决定采用EVAC治疗。治疗包括12个疗程，间隔3至4天，总持续时间40天，进行了5次腔外和7次腔内应用，负压为100至125 mmHg。病情因严重肺炎并发全球呼吸衰竭。术后第58天停止人工通气。患者术后第90天出院至康复机构。出院后3个月的随访证实效果令人满意，完全愈合。
食管切除术后胸内吻合口并发症的治疗已显示出侵入性降低和内镜方法更广泛应用的趋势。尽管有其缺点，但即使对于广泛的吻合口缺损，使用EVAC也是一种安全且高效的治疗选择。其未来的应用、适应证以及与其他治疗选择的关系需要进一步评估。关键词：内镜下真空治疗 - 食管漏出 - 食管切除术后并发症 - 术中内镜检查
