采用标准化窄胃管重建方案后食管切除术吻合口漏发生率低

文献信息

中文摘要

背景： 吻合口漏仍然是食管切除术后最严重的并发症之一，并与发病率、死亡率增加以及长期预后受损相关。尽管已提出多种技术改良以减少漏的发生，但对整个重建过程进行标准化的潜在作用关注较少。我们评估了采用窄胃管和三角形吻合器颈部食管胃吻合的标准化重建方案后的结局。方法：我们回顾性审查了2018年3月至2024年11月期间在2家机构连续接受次全食管切除术后行胃管重建并颈部吻合的115例患者。标准化方案强调保留灌注良好的管状段、优化重建路径以及三角形吻合器颈部食管胃吻合。吻合口漏根据食管切除术并发症共识组（ECCG）标准进行定义和分类。结果：2例患者（1.7%；精确95%置信区间，0.2%-6.1%）发现吻合口漏，均分类为ECCG II型。未发生III型漏。10例（8.7%）发生吻合口狭窄，12例（10.4%）发生喉返神经麻痹，21例（18.3%）发生Clavien-Dindo IIIa级或更高级别并发症。30天和90天死亡率分别为1.7%和2.6%，无与吻合口漏相关的死亡。讨论：标准化窄胃管重建方案与临床识别到的吻合口漏低发生率相关。由于回顾性设计、事件数量少以及缺乏同期对照组，无法确定其优于历史基准。

英文摘要

BackgroundAnastomotic leakage remains one of the most serious complications after esophagectomy and is associated with increased morbidity, mortality, and impaired long-term outcomes. Although various technical modifications have been proposed to reduce leakage, the potential role of standardizing the entire reconstructive procedure has received less attention. We evaluated outcomes after a standardized reconstruction protocol using a narrow gastric conduit and triangular stapled cervical esophagogastrostomy.MethodsWe retrospectively reviewed 115 consecutive patients who underwent subtotal esophagectomy followed by gastric conduit reconstruction with cervical anastomosis at 2 institutions between March 2018 and November 2024. The standardized protocol emphasized preservation of a well-perfused conduit segment, optimization of the reconstruction route, and triangular stapled cervical esophagogastrostomy. Anastomotic leakage was defined and classified according to the Esophagectomy Complications Consensus Group (ECCG) criteria.ResultsAnastomotic leakage was identified in 2 patients (1.7%; exact 95% confidence interval, 0.2%-6.1%), both classified as ECCG Type II. No Type III leaks occurred. Anastomotic stricture developed in 10 patients (8.7%), recurrent laryngeal nerve palsy in 12 (10.4%), and Clavien-Dindo grade IIIa or higher complications in 21 (18.3%). Thirty-day and 90-day mortality were 1.7% and 2.6%, respectively, with no deaths related to anastomotic leakage.DiscussionA standardized narrow gastric conduit reconstruction protocol was associated with a low observed rate of clinically identified anastomotic leakage. Because of the retrospective design, small number of events, and absence of a contemporaneous control group, superiority over historical benchmarks cannot be established.