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食管支架置入术治疗术后瘘的疗效及并发症

Efficiency and Complications of Esophageal Stenting in the Management of Postoperative Fistulas.

作者信息

Rosianu Cristian Gelu, Pușcașu Andreea, Hoara Petre, Predescu Dragos, Birla Rodica, Achim Florin, Strimbu Vlad Codrut, Constantinoiu Silviu, Andronic Octavian, Constantinescu Alexandru

机构信息

Department of General Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.

Gastroenterology Department, "Saint Mary" Clinical Hospital, 011172 Bucharest, Romania.

出版信息

J Clin Med. 2024 Oct 16;13(20):6167. doi: 10.3390/jcm13206167.

Abstract

Esophageal anastomotic fistula (AF) is a frequent and severe complication of an esophagectomy due to esophageal or eso-gastric junction cancer, regardless of the selected surgical technique. AF is usually treated by endoscopic stent placement. : This study aims to examine the efficacy of stents in the treatment of AF, analyzing the healing period and the factors that contribute to its delay. : We collected data from 55 patients who underwent stent implantation for AF, and analyzed multiple variables related to patient healing time and surgical technique with two primary endpoints: post-stenting hospital stay and the time of stent usage until fistula closure. The patients were divided into three groups based on the anastomosis type (eso-gastric anastomosis, eso-gastric cervical anastomosis and eso-jejunal anastomosis) and they were compared using the primary endpoints. : Our findings show the differences between the three groups, with a longer hospital stay for eso-gastric anastomosis, and an extended time of fistula closure in the case of eso-gastric cervical anastomosis. We also found a significant correlation between the size of the fistula and the hospital stay (R = 0.4, < 0.01). Regarding patients' risk factors, our results show an extended post-stenting hospital stay for those patients that underwent preoperative radiotherapy. : Our results offer an extended view of the efficiency, hospitalization duration and healing time for esophageal anastomotic fistula, and reveal some of the factors that interfere with its resolution.

摘要

食管吻合口瘘(AF)是食管或食管胃交界癌食管切除术后常见且严重的并发症,与所选手术技术无关。AF通常通过内镜下放置支架进行治疗。本研究旨在探讨支架治疗AF的疗效,分析愈合期及导致愈合延迟的因素。我们收集了55例行AF支架植入术患者的数据,分析了与患者愈合时间和手术技术相关的多个变量,有两个主要终点:支架置入后的住院时间以及直至瘘口闭合的支架使用时间。根据吻合类型(食管胃吻合、食管胃颈部吻合和食管空肠吻合)将患者分为三组,并使用主要终点进行比较。我们的研究结果显示了三组之间的差异,食管胃吻合患者住院时间更长,食管胃颈部吻合患者瘘口闭合时间延长。我们还发现瘘口大小与住院时间之间存在显著相关性(R = 0.4,P < 0.01)。关于患者的危险因素,我们的结果显示,接受术前放疗的患者支架置入后的住院时间延长。我们的研究结果提供了关于食管吻合口瘘的疗效、住院时间和愈合时间的更全面观点,并揭示了一些影响其愈合的因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c2e1/11508254/1ad2fa3ea027/jcm-13-06167-g001.jpg

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