二次胃上提术后食管皮肤瘘的处理：一例报告
Managing esophagocutaneous fistula after secondary gastric pull-up: A case report.
作者信息
Lock Johan F, Reimer Stanislaus, Pietryga Sebastian, Jakubietz Rafael, Flemming Sven, Meining Alexander, Germer Christoph-Thomas, Seyfried Florian
机构信息
Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg 97080, Germany.
Department of Gastroenterology, University Hospital Würzburg, Würzburg 97080, Germany.
出版信息
World J Gastroenterol. 2021 Apr 28;27(16):1841-1846. doi: 10.3748/wjg.v27.i16.1841.
BACKGROUND
Gastric pull-up (GPU) procedures may be complicated by leaks, fistulas, or stenoses. These complications are usually managed by endoscopy, but in extreme cases multidisciplinary management including reoperation may be necessary. Here, we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.
CASE SUMMARY
A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital. Local and systemic infection originating from the infected fistula was resolved by endoscopy. Hence, elective esophageal reconstruction with free-jejunal interposition was performed with no subsequent adverse events.
CONCLUSION
A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophagocutaneous fistula after GPU. Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.
背景
胃上提术（GPU）可能会出现渗漏、瘘管或狭窄等并发症。这些并发症通常通过内镜检查进行处理，但在极端情况下，可能需要包括再次手术在内的多学科管理。在此，我们报告一种内镜与手术相结合的方法来处理二次GPU手术失败的情况。
病例摘要
一名70岁男性，在二次GPU手术后出现治疗难治性颈段食管皮肤瘘且残余食管狭窄，被转诊至我院三级医院。通过内镜检查解决了源于感染性瘘管的局部和全身感染。因此，进行了择期游离空肠移植食管重建术，术后无不良事件发生。
结论
介入内镜医师和外科医生的多学科方法成功处理了GPU术后颈段食管皮肤瘘引起的严重并发症。内镜治疗可能降低了围手术期风险，促进了游离空肠移植后的原发伤口愈合。
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