[1]杨楠,齐晨,王康.胸腹腔镜下食管鳞癌术后吻合口瘘的预防策略与治疗效果[J].医学研究与战创伤救治(原医学研究生学报),2026,39(01):64-68.[doi:10.16571/j.cnki.2097-2768.2026.01.010]
　YANG Nan,QI Chen,WANG Kang.Prevention strategies and treatment effects of anastomotic leakage after thoracoscopiclaparoscopic esophagectomy for esophageal squamous cell carcinoma[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2026,39(01):64-68.[doi:10.16571/j.cnki.2097-2768.2026.01.010]
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胸腹腔镜下食管鳞癌术后吻合口瘘的预防策略与治疗效果()

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第39卷
期数:
2026年01期
页码:
64-68
栏目:
临床研究
出版日期:
2026-01-20

文章信息/Info

Title:
Prevention strategies and treatment effects of anastomotic leakage after thoracoscopiclaparoscopic esophagectomy for esophageal squamous cell carcinoma
作者:
杨楠; 齐晨; 王康
东部战区总医院心胸外科，江苏南京 210002
Author(s):
YANG Nan;  QI Chen;  WANG Kang
(Department of Cardiothoracic Surgery, General Hospital of Eastern Theater Command, PLA, Nanjing 210002, Jiangsu, China)
关键词:
食管鳞状细胞癌; 管状胃; 吻合口瘘; 胸腔镜; 腹腔镜
Keywords:
esophageal cancer;  tubular stomach;  anastomotic leakage;  thoracoscopy;  laparoscopy
分类号:
R735.1
DOI:
10.16571/j.cnki.2097-2768.2026.01.010
文献标志码:
A
摘要:
目的探讨胸腹腔镜下食管鳞状细胞癌术后食管胃吻合口瘘的危险因素、预防策略及治疗效果。方法回顾性分析2013年12月至2024年12月东部战区总医院心胸外科收治的1084例食管癌患者的临床资料。其中114例（10.5%）出现吻合口瘘为吻合口瘘组，970例（89.5%）未发生吻合口瘘为对照组。根据吻合口瘘发生的时间，将其进一步划分为早期（1~3 d）、中期（4~14 d）和晚期（14 d以上）三个阶段。针对吻合口颈部瘘采取及时置入双套管冲洗加小负压引流的治疗措施；对于吻合口纵隔胸腔瘘实施内镜下经鼻瘘口管置入，持续小负压引流并间断冲洗的治疗方案；所有患者均接受了联合抗感染治疗以及肠内外营养支持。比较患者的基础资料、术中及术后情况及分析吻合口瘘的危险因素。结果1084例接受McKeown手术的食管癌患者中114例（10.5%）出现吻合口瘘。多因素分析显示，年龄、性别、糖尿病、术后肺部感染是术后吻合口瘘的危险因素（P< 0.05）。吻合口颈部瘘患者2周内、2个月内愈合分别为39.1%、63%，仅27.3%的吻合口纵隔胸腔瘘患者在2个月内愈合。吻合口颈部瘘患者的中位愈合时间为17 d，而吻合口纵隔胸腔瘘的中位愈合时间为35 d,差异有统计学意义（P<0.001）。随访发现有20例（17.4%）吻合口瘘愈合患者表现出吻合口狭窄的临床症状。结论针对高危患者（如高龄、男性、糖尿病或术后肺部感染者）应加强围手术期管理，优化手术技术以减少吻合口张力及血供障碍。此外，术后早期发现、充分引流（颈部瘘采用双套管冲洗联合负压引流，纵隔胸腔瘘采用内镜下经鼻引流）及营养支持是改善吻合口瘘预后的关键措施。
Abstract:
ObjectiveTo investigate the risk factors, prevention strategies, and treatment effects of esophagogastric anastomotic leakage following thoracoscopiclaparoscopic surgery for esophageal squamous cell carcinoma.MethodsA retrospective analysis was conducted on the clinical data of 1,084 esophageal cancer patients admitted to the Department of Cardiothoracic Surgery at the General Hospital of the Eastern Theater Command from December 2013 to December 2024. Among them, 114 patients (10.5%) developed anastomotic leakage (leakage group), while 970 (89.5%) did not (control group). Based on the timing of leakage occurrence, cases were further categorized into early (1-3 days), intermediate (4-14 days), and late (beyond 14 days) stages. For cervical anastomotic leaks, timely placement of a doublelumen catheter for irrigation combined with low negativepressure drainage was implemented. For mediastinalthoracic leaks, endoscopic transnasal fistula tube placement with continuous low negativepressure drainage and intermittent irrigation was adopted. All patients received combined antiinfection therapy and enteral/parenteral nutritional support. Baseline clinical data, intraoperative and postoperative conditions were compared, and risk factors for anastomotic leakage were analyzed.ResultsAmong the 1,084 esophageal cancer patients undergoing McKeown surgery, 114 (10.5%) developed anastomotic leakage. Multivariate analysis identified age, sex, diabetes mellitus, and postoperative pulmonary infection as independent risk factors for anastomotic leakage (P<0.05). For cervical leaks, the healing rates within 2 weeks and 2 months were 39.1% and 63%, respectively, whereas only 27.3% of mediastinalthoracic leaks healed within 2 months. The median healing time for cervical leaks was 17 days, significantly shorter than the 35 days for mediastinalthoracic leaks. The differences showed statistically significant (P<0.001). Followup revealed that 20 patients (17.4%) with healed leaks exhibited clinical symptoms of anastomotic stenosis.ConclusionPerioperative management should be intensified for highrisk patients (e.g., elderly, male, diabetic, or those with postoperative pulmonary infections), and surgical techniques should be optimized to reduce anastomotic tension and blood supply impairment. Additionally, early detection, adequate drainage (doublelumen irrigation with negativepressure drainage for cervical leaks; endoscopic transnasal drainage for mediastinalthoracic leaks), and nutritional support are critical measures to improve the prognosis of anastomotic leakage.

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备注/Memo

备注/Memo:
基金项目：东部战区总医院科研基金(2023LCZLXA040)
更新日期/Last Update: 2026-01-20