食管切除术后吻合口瘘相关危险因素及治疗策略分析

Analysis of Risk Factors and Treatment Strategy of Anastomotic Leakage after Esophagectomy

摘要: 目的：食管切除术后吻合口瘘是食管癌手术治疗最严重的并发症之一，目前手术治疗仍是食管癌最重要的治疗手段。本研究就食管癌(esophageal carcinoma, EC)术后吻合口瘘的定义、分类、危险因素、诊断与治疗方法等方面的研究现状进行回顾性综述。方法：检索PubMed，中国知网，临床试验注册台(Clinical Trials.gov)，以食管癌，食管癌根治术，吻合口瘘，危险因素为关键词，检索2000~2020的相关文献，纳入标准：1) 食管癌术后吻合口瘘的危险因素；2) 吻合口瘘的治疗及预防措施；3) 吻合口瘘的实验室及影像学诊断。根据纳入标准分析45篇。结果：食管癌术后吻合口瘘的临床症状和严重程度多种多样，再加上种类繁多的诊断和治疗技术，使得目前AL的临床治疗仍是基于个体化的治疗方法。结论：食管癌术后吻合口瘘严重影响着患者的治疗质量和生命安全，外科医师应当重视该并发症的预防及治疗，对于高危患者应事先采取预防措施；对于怀疑吻合口瘘的患者，应当早发现、早治疗。

Abstract: Objective: Anastomotic leakage after esophagectomy is one of the most serious complications in the surgical treatment of esophageal cancer. Surgical treatment is still the most important treatment for esophageal cancer. In this study, the research status of definition, classification, risk factors, diagnosis and treatment of anastomotic leakage after esophageal cancer operation was reviewed retrospectively. Methods: Search PubMed, CNKI, Clinical Trial Registration Station (Clinical Trials.gov), with “esophageal cancer, radical resection of esophageal cancer, anastomotic fistula, risk factors” from 2000 to 2020. Inclusion criteria are: 1) risk factors of anastomotic fistula after esophageal cancer operation; 2) treatment and prevention of anastomotic leakage; 3) laboratory and imaging diagnosis of anastomotic leakage. Forty-five articles were analyzed according to inclusion criteria. Results: The clinical symptoms and severity of anastomotic leakage after esophageal cancer operation are varied, so as diagnostic and therapeutic techniques. Thus the clinical treatment of AL (anastomotic leakage) is still based on individualized treatment. Conclusion: Anastomotic leakage after esophageal cancer surgery seriously affects the quality of the treatment and safety of patients. Surgeons should pay much more attention to the prevention and treatment of this complication. Precautionary measures should be taken for the high-risk patients. For patients suspected of anastomotic fistula, early detection and treatment should be performed. Additionally it should be detected and treated early for suspicious patients.