Athanasiou Antonios, Hennessy Mairead, Spartalis Eleftherios, Tan Benjamin H L, Griffiths Ewen A
Department of Upper GI, Bariatric and Minimally Invasive Surgery, St. James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom.
Department of Anaesthesia, University Hospital of Waterford, Waterford X91 ER8E, Ireland.
World J Gastrointest Surg. 2019 Mar 27;11(3):155-168. doi: 10.4240/wjgs.v11.i3.155.
Esophageal conduit ischaemia and necrosis is an uncommon but devastating complication of esophagectomy and remains one of the most challenging issues in surgical practice. The incidence, time interval to develop symptoms, and clinical presentation are highly variable with no predictable pattern. Evidence comes from case reports and case series rather than randomized controlled trials. We describe the issues surrounding conduit necrosis affecting the stomach, jejunum and colon as an esophageal replacement and the advantages, disadvantages and challenges of each type of reconstruction. Diagnosis is challenging for the most experienced surgeon. Upper gastrointestinal endoscopy and computed tomography thorax with both oral and intravenous contrast is the gold standard. Management, either conservative or interventional is also a difficult decision. Management options include conservative treatment and more aggressive treatments such as stent insertion, surgical debridement and repair of the esophagus using jejunum, colon or a musculocutaneous flap. In spite of recent advances in surgical techniques, there is no reliable strategy to manage esophageal conduit necrosis. Our review covers the pathophysiology and clinical significance of esophageal necrosis while highlighting current techniques of prevention, diagnosis and treatment of this life-threatening condition.
食管替代物缺血坏死是食管切除术中一种罕见但极具破坏性的并发症，仍是外科实践中最具挑战性的问题之一。其发病率、出现症状的时间间隔和临床表现差异很大，没有可预测的模式。证据来自病例报告和病例系列，而非随机对照试验。我们描述了影响胃、空肠和结肠作为食管替代物的替代物坏死相关问题，以及每种重建类型的优缺点和挑战。对于经验最丰富的外科医生来说，诊断也具有挑战性。上消化道内镜检查以及口服和静脉注射造影剂的胸部计算机断层扫描是金标准。无论是保守治疗还是介入治疗，管理也是一个艰难的决定。管理选择包括保守治疗以及更积极的治疗，如支架置入、手术清创和使用空肠、结肠或肌皮瓣修复食管。尽管手术技术最近有所进步，但尚无可靠的策略来处理食管替代物坏死。我们的综述涵盖了食管坏死的病理生理学和临床意义，同时突出了目前针对这种危及生命状况的预防、诊断和治疗技术。
