切换至 "中华医学电子期刊资源库"

中华胸部外科电子杂志 ›› 2023, Vol. 10 ›› Issue (01) : 50 -56. doi: 10.3877/cma.j.issn.2095-8773.2023.01.09

综述

食管癌术后吻合口瘘临床管理进展
朱开元1, 李志刚1,()   
  1. 1. 200030 上海,上海市胸科医院/上海交通大学医学院附属胸科医院胸外科
  • 收稿日期:2022-08-24 修回日期:2022-10-31 接受日期:2022-11-15 出版日期:2023-02-28
  • 通信作者: 李志刚

Progress in clinical management of anastomotic leakage after esophageal cancer surgery

Kaiyuan Zhu1, Zhigang Li1,()   

  1. 1. Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
  • Received:2022-08-24 Revised:2022-10-31 Accepted:2022-11-15 Published:2023-02-28
  • Corresponding author: Zhigang Li
引用本文:

朱开元, 李志刚. 食管癌术后吻合口瘘临床管理进展[J]. 中华胸部外科电子杂志, 2023, 10(01): 50-56.

Kaiyuan Zhu, Zhigang Li. Progress in clinical management of anastomotic leakage after esophageal cancer surgery[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2023, 10(01): 50-56.

食管癌是我国常见的恶性肿瘤之一,目前针对可切除食管癌患者的治疗方案仍以手术治疗为主。吻合口瘘是食管癌切除术后常见的消化道并发症,它的临床表现极其庞杂,从无症状到脓毒血症伴多脏器衰竭都有可能发生。发生吻合口瘘会增加患者90天死亡率,为患者和医生带来额外的经济和工作负担。预防吻合口瘘及选择合理有效的治疗方案可使患者显著获益。目前临床上处理术后吻合口瘘的治疗方案主要有保守治疗、非手术治疗和手术治疗3种。普遍认为应该针对吻合口瘘的特征来选择治疗方案,但对于何种方案使患者获益最大,尚未形成统一的认知。因此目前需要有更多的临床数据来证明特定治疗方式的确定适应证,以辅助临床医生在治疗方案上做出最优的选择。

Esophageal carcinoma is one of the most common malignant tumors in China. At present, the main treatment regimen for resectable esophageal cancer is still surgery. Anastomotic leakage is a common complication after esophagectomy. Its clinical manifestations are extremely complex, ranging from asymptomatic to sepsis with multiple organ failure. The occurrence of anastomotic leakage will increase the 90-day mortality of patients and impose medical and financial burden to physicians and patients. The prevention of anastomotic leakage and the rational choice of treatment can benefit patients significantly. Currently, the clinical treatment of postoperative anastomotic leakage mainly includes conservative treatment, non-operative treatment and operative treatment. It is generally believed that the treatment should be chosen according to the characteristics of anastomotic leakage, but there is no consensus on which treatment benefits the patients most. Therefore, more clinical data are currently needed to prove the advantages of a certain treatment for definite indications, so as to assist the physicians to make the optimal choice.

1
Sung HFerlay JSiegel RL,et al.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J].CA Cancer J Clin202171(3):209-249.
2
Xia CDong XLi H,et al.Cancer statistics in China and United States, 2022: profiles, trends, and determinants[J].Chin Med J (Engl)2022135(5):584-590.
3
Arnold MAbnet CCNeale RE,et al.Global Burden of 5 Major Types of Gastrointestinal Cancer[J].Gastroenterology2020159(1):335-349.
4
Pandeya NOlsen CMWhiteman DC.Sex differences in the proportion of esophageal squamous cell carcinoma cases attributable to tobacco smoking and alcohol consumption[J].Cancer Epidemiol201337(5):579-584.
5
Sheikh MPoustchi HPourshams A,et al.Individual and Combined Effects of Environmental Risk Factors for Esophageal Cancer Based on Results From the Golestan Cohort Study[J].Gastroenterology2019156(5):1416-1427.
6
van Hagen PHulshof MCvan Lanschot JJ,et al.Preoperative chemoradiotherapy for esophageal or junctional cancer[J].N Engl J Med2012366(22):2074-2084.
7
Ajani JAD'Amico TABentrem DJ,et al.Esophageal and Esophagogastric Junction Cancers, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology[J].J Natl Compr Canc Netw201917(7):855-883.
8
Markar SGronnier CDuhamel A,et al.The Impact of Severe Anastomotic Leak on Long-term Survival and Cancer Recurrence After Surgical Resection for Esophageal Malignancy[J].Ann Surg2015262(6):972-980.
9
Low DEKuppusamy MKAlderson D,et al.Benchmarking Complications Associated with Esophagectomy[J].Ann Surg2019269(2):291-298.
10
Rates of Anastomotic Complications and Their Management Following Esophagectomy: Results of the Oesophago-Gastric Anastomosis Audit (OGAA)[J].Ann Surg2022275(2):e382-e391.
11
Goense LMeziani JRuurda JP,et al.Impact of postoperative complications on outcomes after oesophagectomy for cancer[J].Br J Surg2019106(1):111-119.
12
Rutegård MLagergren PRouvelas I,et al.Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study[J].Ann Surg Oncol201219(1):99-103.
13
Kamarajah SKNavidi MWahed S,et al.Anastomotic Leak Does Not Impact on Long-Term Outcomes in Esophageal Cancer Patients[J].Ann Surg Oncol202027(7):2414-2424.
14
Shogan BDBelogortseva NLuong PM,et al.Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak[J].Sci Transl Med20157(286):286ra68.
15
Raymond DPSeder CWWright CD,et al.Predictors of Major Morbidity or Mortality After Resection for Esophageal Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Risk Adjustment Model[J].Ann Thorac Surg2016102(1):207-214.
16
Sato SNakatani EHigashizono K,et al.Size of the thoracic inlet predicts cervical anastomotic leak after retrosternal reconstruction after esophagectomy for esophageal cancer[J].Surgery2020168(3):558-566.
17
Verstegen MHPSlaman AEKlarenbeek BR,et al.Outcomes of Patients with Anastomotic Leakage After Transhiatal, McKeown or Ivor Lewis Esophagectomy: A Nationwide Cohort Study[J].World J Surg202145(11):3341-3349.
18
Lanting SMJohnson NABaker MK,et al.The effect of exercise training on cutaneous microvascular reactivity: A systematic review and meta-analysis[J].J Sci Med Sport201720(2):170-177.
19
Oesophago-Gastric Anastomosis Study Group (OGAA) on behalf of the West Midlands Research Collaborative.Postoperative outcomes in oesophagectomy with trainee involvement[J].BJS Open20215(6):zrab132.
20
Kamarajah SKBoyle CBundred JR,et al.Critical appraisal of gastric conduit ischaemic conditioning (GIC) prior to oesophagectomy: A systematic review and meta-analysis[J].Int J Surg202077:77-82.
21
Tu RHLin JXZheng CH,et al.Development of a nomogram for predicting the risk of anastomotic leakage after a gastrectomy for gastric cancer[J].Eur J Surg Oncol201743(2):485-492.
22
Jin ZZhang JChen D,et al.Neoadjuvant chemoradiotherapy, chemotherapy, and radiotherapy do not significantly increase the incidence of anastomotic leakage after esophageal cancer surgery: a meta-analysis[J].Dis Esophagus202235(9):doab089.
23
Sepesi BSwisher SGWalsh GL,et al.Omental reinforcement of the thoracic esophagogastric anastomosis: an analysis of leak and reintervention rates in patients undergoing planned and salvage esophagectomy[J].J Thorac Cardiovasc Surg2012144(5):1146-1150.
24
Pathak DPennefather SHRussell GN,et al.Phenylephrine infusion improves blood flow to the stomach during oesophagectomy in the presence of a thoracic epidural analgesia[J].Eur J Cardiothorac Surg201344(1):130-133.
25
Mukai ASuehiro KWatanabe R,et al.Impact of intraoperative goal-directed fluid therapy on major morbidity and mortality after transthoracic oesophagectomy: a multicentre, randomised controlled trial[J].Br J Anaesth2020125(6):953-961.
26
Schietroma MCecilia EMCarlei F,et al.Prevention of anastomotic leakage after total gastrectomy with perioperative supplemental oxygen administration: a prospective randomized, double-blind, controlled, single-center trial[J].Ann Surg Oncol201320(5):1584-1590.
27
Biere SSMaas KWCuesta MA,et al.Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis[J].Dig Surg201128(1):29-35.
28
van Workum FVerstegen MHPKlarenbeek BR,et al.Intrathoracic vs Cervical Anastomosis After Totally or Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer: A Randomized Clinical Trial[J].JAMA Surg2021156(7):601-610.
29
Miyawaki YSato HFujiwara N,et al.Evaluation of the Associations between Gastric Tube Preparation Methods and the Incidence of Cervical Anastomotic Leakage after Esophagectomy for Thoracic Esophageal Cancer[J].Dig Surg202037(2):154-162.
30
Tu DHQu RPing W,et al.Anastomosis oversewing technique to prevent leakage after oesophagectomy: a propensity score-matched analysis[J].Eur J Cardiothorac Surg202261(5):990-998.
31
Müller PCMorell BVetter D,et al.Preemptive Endoluminal Vacuum Therapy to Reduce Morbidity After Minimally Invasive Ivor Lewis Esophagectomy: Including a Novel Grading System for Postoperative Endoscopic Assessment of GI-Anastomoses[J]. Ann Surg2021274(5):751-757.
32
Koyanagi KOzawa SNinomiya Y,et al.Association between indocyanine green fluorescence blood flow speed in the gastric conduit wall and superior mesenteric artery calcification: predictive significance for anastomotic leakage after esophagectomy[J].Esophagus202118(2):248-257.
33
Lee YLu JYMalhan R,et al.Effect of routine jejunostomy tube insertion in esophagectomy: A systematic review and meta-analysis[J].J Thorac Cardiovasc Surg2022164(2):422-432.e17.
34
Viklund PLindblad MLu M,et al.Risk factors for complications after esophageal cancer resection: a prospective population-based study in Sweden[J].Ann Surg2006243(2):204-211.
35
Kassis ESKosinski ASRoss P Jr,et al.Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database[J].Ann Thorac Surg201396(6):1919-1926.
36
Iversen LHThomsen GHThorlacius-Ussing O.Systemic coagulation activation and anastomotic leakage after colorectal cancer surgery[J].Dis Colon Rectum199942(1):56-65.
37
Kubo YTanaka KYamasaki M,et al.The Impact of Perioperative Fluid Balance on Postoperative Complications after Esophagectomy for Esophageal Cancer[J].J Clin Med2022, 11(11):3219.
38
Goense Lvan Rossum PSTromp M,et al.Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer[J].Dis Esophagus201730(1):1-10.
39
Low DEAlderson DCecconello I,et al.International Consensus on Standardization of Data Collection for Complications Associated With Esophagectomy: Esophagectomy Complications Consensus Group (ECCG)[J].Ann Surg2015262(2):286-294.
40
Korst RJPort JLLee PC,et al.Intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy for carcinoma[J].Ann Thorac Surg200580(4):1185-1190.
41
Elliott IABerry MFTrope W,et al.Half of Anastomotic Leaks After Esophagectomy Are Undetected on Initial Postoperative Esophagram[J].Ann Thorac Surg2023115(3):719-724.
42
Page RDAsmat AMcShane J,et al.Routine endoscopy to detect anastomotic leakage after esophagectomy[J].Ann Thorac Surg201395(1):292-298.
43
Hogan BAWinter DCBroe D,et al.Prospective trial comparing contrast swallow, computed tomography and endoscopy to identify anastomotic leak following oesophagogastric surgery[J].Surg Endosc200822(3):767-771.
44
Linden PATowe CWWorrell SG,et al.Drain Amylase: A Simple and Versatile Method of Detecting Esophageal Anastomotic Leaks[J].Ann Thorac Surg2022113(6):1794-1800.
45
Williams RNHall AWSutton CD,et al.Management of esophageal perforation and anastomotic leak by transluminal drainage[J].J Gastrointest Surg201115(5):777-781.
46
Speer EDunst CMShada A,et al.Covered stents in cervical anastomoses following esophagectomy[J].Surg Endosc201630(8):3297-3303.
47
Schweigert MDubecz AStadlhuber RJ,et al.Risk of stent-related aortic erosion after endoscopic stent insertion for intrathoracic anastomotic leaks after esophagectomy[J].Ann Thorac Surg201192(2):513-518.
48
Weidenhagen RHartl WHGruetzner KU,et al.Anastomotic leakage after esophageal resection: new treatment options by endoluminal vacuum therapy[J].Ann Thorac Surg201090(5):1674-1681.
49
Scognamiglio PReeh MKarstens K,et al.Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: systematic review and meta-analysis[J].Endoscopy202052(8):632-642.
50
Almoudaris AMBurns EMMamidanna R,et al.Value of failure to rescue as a marker of the standard of care following reoperation for complications after colorectal resection[J].Br J Surg201198(12):1775-1783.
51
Page RDShackcloth MJRussell GN,et al.Surgical treatment of anastomotic leaks after oesophagectomy[J].Eur J Cardiothorac Surg200527(2):337-343.
52
Fujita TDaiko HNishimura M.Early enteral nutrition reduces the rate of life-threatening complications after thoracic esophagectomy in patients with esophageal cancer[J].Eur Surg Res201248(2):79-84.
53
Verstegen MHPBouwense SAWvan Workum F,et al.Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review[J].World J Emerg Surg201914:17.
54
Hoek VTEdomskis PPMenon AG,et al.Arterial calcification is a risk factor for anastomotic leakage after esophagectomy: A systematic review and meta-analysis[J].Eur J Surg Oncol202046(11):1975-1988.
[1] 陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志(电子版), 2023, 20(09): 974-978.
[2] 杜滨和, 徐楠, 杨云川, 崔培元. 5项改良衰弱指数预测胰十二指肠切除术近期预后的价值探讨[J]. 中华普通外科学文献(电子版), 2023, 17(06): 444-448.
[3] 李建美, 邓静娟, 杨倩. 两种术式联合治疗肝癌合并肝硬化门静脉高压的安全性及随访评价[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 41-44.
[4] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[5] 杨体飞, 杨传虎, 陆振如. 改良无充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 74-77.
[6] 陈大敏, 曹晓刚, 曹能琦. 肥胖对胃癌患者手术治疗效果的影响研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 651-653.
[7] 陈垚, 徐伯群, 高志慧. 改良式中间上入路根治术治疗甲状腺癌的有效性安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 619-622.
[8] 王敏, 蒋家斌, 李茂新. 预警宣教联合个性化疼痛管理对腹股沟疝手术患者的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 764-767.
[9] 朱青青, 卫贞祺. 腹股沟疝患者围手术期自我能效管理探讨[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 773-777.
[10] 潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强. 淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 608-612.
[11] 崔佳琪, 吴迪, 陈海艳, 周惠敏, 顾元龙, 周光文, 杨军. TACE术后并发肝脓肿的临床诊治分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 688-693.
[12] 侯超, 潘美辰, 吴文明, 黄兴广, 李翔, 程凌雪, 朱玉轩, 李文波. 早期食管癌及上皮内瘤变内镜黏膜下剥离术后食管狭窄的危险因素[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 383-387.
[13] 单秋洁, 孙立柱, 徐宜全, 王之霞, 徐妍, 马浩, 刘田田. 中老年食管癌患者调强放射治疗期间放射性肺损伤风险模型构建及应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 388-393.
[14] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[15] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
阅读次数
全文


摘要