Wilson S E, Stone R, Scully M, Ozeran L, Benfield J R
Am J Surg. 1982 Jul;144(1):95-101. doi: 10.1016/0002-9610(82)90608-0.
From 1970 to 1981, 167 patients, aged 35 to 84 years (mean 61), underwent resection of 94 adenocarcinomas and 73 squamous cell cancers. The operative mortality was 8.9 percent. Anastomotic leaks occurred in 19 patients (11.3 percent), including 18 of 72 (25 percent) after operations for palliation and 1 of 95 (1 percent) after procedures with curative potential (p less than 0.01). The leakage rate after esophagogastrostomy was 8.5 percent, compared with 43 percent after interposition operations. No leak is attributed to cancer in anastomotic margins. In contrast to previous reports of greater than 50 percent mortality from leaks, only 21 percent of our patients died in the past decade. Four of 19 contained leaks (sinus tract or upper gastrointestinal) were treated nonoperatively; esophagostomy was used only once. Factors responsible for improving results include early diagnosis with routine contrast studies on the fifth to seventh postoperative days, mandatory use of total parenteral nutrition, nonoperative management of contained leaks, accurate, aggressive use of adjuvant chest tubes, and selective esophagostomy for anastomotic disruption.
1970年至1981年期间，167例年龄在35至84岁（平均61岁）的患者接受了94例腺癌和73例鳞状细胞癌的切除术。手术死亡率为8.9%。19例（11.3%）发生吻合口漏，其中姑息手术后72例中有18例（25%），有治愈可能的手术后95例中有1例（1%）（P<0.01）。食管胃吻合术后漏率为8.5%，相比之下，间置术后漏率为43%。吻合口漏均与吻合边缘的癌无关。与之前报道的漏导致死亡率超过50%不同，在过去十年中我们的患者只有21%死亡。19例有漏（窦道或上消化道）的患者中有4例接受了非手术治疗；食管造口术仅使用过一次。改善结果的因素包括术后第五至七天通过常规造影检查进行早期诊断、强制使用全胃肠外营养、对局限性漏进行非手术处理、准确积极地使用辅助胸管以及对吻合口破裂进行选择性食管造口术。
