Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA.
Am Surg. 2020 Oct;86(10):1411-1417. doi: 10.1177/0003134820964495. Epub 2020 Oct 19.
Anastomotic leak is a dreaded complication following esophagectomy. Conventional management for leaks includes invasive reoperation and even gastrointestinal diversion.
The aim of this study was to examine our contemporary outcome of using endoscopic esophageal stenting as primary therapy for management of anastomotic leak following minimally invasive esophagectomy (MIE).
We reviewed data on 11 patients who developed an esophageal leak following 111 MIE between January 2011 and December 2019. Of the 11 anastomotic leaks, 10 patients had an anastomotic disruption and underwent endoscopic esophageal stenting as primary therapy for management of leaks, while 1 patient had an anastomotic disruption complicated by an associated tracheoesophageal fistula that required surgical reoperation and subsequent colonic interposition. Main outcome measures focused on the 10 patients who were managed with endoscopic stenting, including length of hospital stay following leak management, need for thoracotomy or gastrointestinal diversion for leak, stent complications, and leak-associated mortality.
Of the 10 patients who underwent endoscopic esophageal stenting as primary therapy for management of leaks, there were 8 males with a median age of 66 years. The median time to diagnosis of anastomotic leak was 10 days postoperatively. One of the ten patients also underwent percutaneous drain placement, while none of the patients required thoracotomy. Median duration of stent placement was 39 (range, 29-105) days. Median length of stay after stent placement was 10 (range, 4-43) days. The median number of stent exchange was 1 (range, 1-3) stent. Gastrointestinal continuity was maintained in all patients. The 90-day leak-associated mortality was 9.1% (1 of 11 patients).
Endoscopic stenting is an effective primary therapy in the management of postesophagectomy leak and avoids the need for an invasive, reoperative thoracotomy or gastrointestinal diversion procedure.
吻合口漏是食管切除术后一种可怕的并发症。传统的漏口处理方法包括有创的再次手术，甚至胃肠转流。
本研究旨在探讨我们采用内镜食管支架作为微创食管切除术（MIE）后吻合口漏的主要治疗方法的当代结果。
我们回顾了 2011 年 1 月至 2019 年 12 月期间 111 例 MIE 后发生食管漏的 11 例患者的数据。在 11 例吻合口漏中，10 例患者发生吻合口破裂，采用内镜食管支架作为主要治疗方法治疗漏口，而 1 例患者发生吻合口破裂并伴有相关的气管食管瘘，需要手术再次手术和随后的结肠间置。主要观察指标集中在 10 例接受内镜支架治疗的患者，包括漏口管理后住院时间、漏口需要开胸或胃肠转流、支架并发症和漏口相关死亡率。
10 例患者接受内镜食管支架作为主要治疗方法治疗漏口，其中 8 例为男性，中位年龄为 66 岁。吻合口漏的中位诊断时间为术后 10 天。其中 1 例患者还接受了经皮引流管放置，而无患者需要开胸。中位支架放置时间为 39（范围，29-105）天。支架放置后中位住院时间为 10（范围，4-43）天。中位支架更换次数为 1（范围，1-3）次。所有患者均保持胃肠道连续性。90 天漏口相关死亡率为 9.1%（11 例患者中的 1 例）。
内镜支架置入是治疗食管切除术后漏口的有效方法，可避免有创的再次手术开胸或胃肠转流。
