食管胃结合部腺癌腹腔镜术后吻合口漏处理策略的选择

Management of anastomotic leakage after laparoscopic surgery for adenocarcinoma of esophagogastric junction

食管胃结合部腺癌(AEG)的发病率在国内外均呈上升趋势。目前,腹腔镜外科手术已逐渐成为AEG外科治疗的主要手段,但因肿瘤解剖位置特殊、离断食管位置较高以及纵隔区域空间狭小而致腹腔镜下吻合存在吻合难度大、吻合位置高等特点,术后发生吻合口漏风险较大,可能造成严重后果。对于其吻合口漏的处理,本文从基本原理、内镜治疗和外科治疗三个方面进行了探讨。早期识别吻合口漏,并通过多种手段通畅引流,是治疗的关键。随着内镜技术的发展,覆膜支架及负压闭合治疗等内镜手段的采用,进一步提高了吻合口漏的治疗效果。外科手术作为一种补救措施,虽然可取得较好的治疗结局,但也伴随着多种并发症及死亡风险,因而必须严格把握手术指征。

The incidence of adenocarcinoma of esophagogastric junction(AEG)is increasing at home and abroad.Laparoscopic surgery has gradually become the main means of surgical treatment of this kind of tumor.However,due to the special anatomical position of the tumor,the high position away from the broken esophagus and the narrow space in the mediastinum,laparoscopic anastomosis has the characteristics of difficult anastomosis and high anastomosis position.There is a high risk of anastomotic leakage after operation,which may cause serious consequences.Early identification of anastomotic leakage and unobstructed drainage by various means are the key to treatment.With the development of endoscopic technology,endoscopic methods such as covered stent and vacuum⁃assisted closure further improve the treatment efficacy.As a salvage measure,surgical treatment can achieve good treatment outcome,while accompanied by risk of complications and mortality,so we must strictly grasp the indications.