Zhou Jian, Wang Zhenhong, Chen Guobiao, Li Yi, Cai Min, Pannikkodan Fathima Shifly, Qin Xiangzhi, Bai Dan, Lv Zhenbing, Gong Lei, Tian Yunhong
Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, China.
Department of Plastic Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China.
World J Surg Oncol. 2024 Dec 30;22(1):353. doi: 10.1186/s12957-024-03647-4.
The aim of this study was to introduce the Esophagus-Sparing Anastomotic Narrowing Revision (ESANR) technique for the intraoperative management of anastomotic narrowing and to conduct a literature review to provide an algorithm for the management of narrowing and strictures that may develop secondary to esophagojejunostomy.
Three patients with anastomotic narrowing during esophagojejunostomy were analyzed between September 2019 and June 2024. The anastomotic narrowing was detected by intraoperative gastroscopy after reconstruction. The ESANR technique was performed for the management of anastomotic narrowing. We conducted a systematic search of PubMed, Embase, and Web of Science databases for studies published up to June 2024 related to the treatment of anastomotic stricture. Data on the number of patients, sex, age, type of anastomosis, treatment, and outcomes were collected.
The ESANR technique proved effective for the management of anastomotic narrowing in patients who underwent esophagojejunostomy during gastric cancer surgery. No anastomotic stricture or leakage was found following ESANR, and all three patients recovered without complications. 12 studies with a total of 174 patients were analyzed. The management of anastomotic stricture, which included Balloon Dilation (BD), Endoscopic Incision Therapy (EIT), stent placement, Endoscopic combination therapy (Needle-Knife stricturotomy NKS, Balloon Dilation with Triamcinolone Injection TAC), and re-do laparoscopic esophagojejunostomy.
In conclusion, the ESANR technique demonstrates potential advantages in addressing anastomotic narrowing in esophagojejunostomy. However, further clinical data and analyses are necessary to verify its effectiveness and establish robust statistical support.
本研究旨在介绍保留食管的吻合口狭窄修复（ESANR）技术用于吻合口狭窄的术中管理，并进行文献综述，以提供一种针对因食管空肠吻合术继发的狭窄和缩窄的管理算法。
分析2019年9月至2024年6月期间3例食管空肠吻合术中出现吻合口狭窄的患者。重建后通过术中胃镜检测吻合口狭窄。采用ESANR技术处理吻合口狭窄。我们对PubMed、Embase和Web of Science数据库进行了系统检索，以查找截至2024年6月发表的与吻合口狭窄治疗相关的研究。收集患者数量、性别、年龄、吻合类型、治疗方法及结果等数据。
ESANR技术被证明对胃癌手术中接受食管空肠吻合术患者的吻合口狭窄管理有效。ESANR术后未发现吻合口狭窄或渗漏，3例患者均康复且无并发症。分析了12项研究，共174例患者。吻合口狭窄的管理方法包括球囊扩张（BD）、内镜切开治疗（EIT）、支架置入、内镜联合治疗（针刀切开术NKS、曲安奈德注射球囊扩张TAC）以及再次腹腔镜食管空肠吻合术。
总之，ESANR技术在解决食管空肠吻合口狭窄方面显示出潜在优势。然而，需要进一步的临床数据和分析来验证其有效性并建立有力的统计学支持。
