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中华腔镜外科杂志(电子版) ›› 2025, Vol. 18 ›› Issue (06) : 379 -384. doi: 10.3877/cma.j.issn.1674-6899.2025.06.010

综述

食管癌根治术后吻合口瘘的研究进展
陈瑞骥1, 陈思禹3, 任红4, 杨博2, 刘阳2,()   
  1. 1572010 三亚,中国人民解放军总医院海南医院胸外科
    2100853 北京,解放军总医院第一医学中心胸外科
    3100048 北京,解放军总医院第六医学中心胸外科
    4300071 天津,南开大学医学院
  • 收稿日期:2025-11-12 出版日期:2025-12-30
  • 通信作者: 刘阳

Progress in the research of anastomotic leakage after radical surgery of esophageal cancer

Ruiji Chen1, Siyu Chen3, Hong Ren4, Bo Yang2, Yang Liu2,()   

  1. 1Department of thoracic surgery, Hainan hospital of Chinese General Hospital of PLA, Sanya 572010, China
    2Department of Thoracic Surgery, First Medical Center of the PLA General Hospital, Beijing 100853, China
    3Department of Thoracic Surgery, the 6th Medical Center of PLA General Hospital, Beijing 100048, China
    4School of Medicine, Nankai University, Tianjin 300071, China
  • Received:2025-11-12 Published:2025-12-30
  • Corresponding author: Yang Liu
引用本文:

陈瑞骥, 陈思禹, 任红, 杨博, 刘阳. 食管癌根治术后吻合口瘘的研究进展[J/OL]. 中华腔镜外科杂志(电子版), 2025, 18(06): 379-384.

Ruiji Chen, Siyu Chen, Hong Ren, Bo Yang, Yang Liu. Progress in the research of anastomotic leakage after radical surgery of esophageal cancer[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(06): 379-384.

食管癌是中国高发特发的消化道恶性肿瘤,手术是其重要的治疗手段。然而,吻合口瘘是术后高发且严重的并发症,对围手术期死亡率及远期生存均有不良影响。本综述总结了食管癌根治术后吻合口瘘的临床特点、高危因素及预防治疗进展,以期未来对降低这种并发症发生率、改进其治疗方案提供参考。

Esophageal cancer is a highly prevalent and specific malignant tumor of the digestive tract in China, and surgery is an important treatment for esophageal cancer. However, anastomotic leakage is a high incidence and serious postoperative complication, which adversely affects perioperative mortality and long-term survival. This article summarizes the clinical characteristics, high-risk factors, and progress of prevention and treatment of anastomotic leakage after radical surgery for esophageal cancer, with a view to providing future references for reducing the incidence of this complication and improving its treatment prognosis.

1
Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249.
2
Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4(1):47-53.
3
Chen R, Zheng R, Zhang S, et al. Patterns and trends in esophageal cancer incidence and mortality in China: an analysis based on cancer registry data[J]. J Natl Cancer Cent, 2023, 3(1):21-27.
4
Aadam AA, Abe S. Endoscopic submucosal dissection for superficial esophageal cancer[J]. Dis Esophagus, 2018, 31(7).
5
Yang H, Liu H, Chen Y, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): a phase iii multicenter, randomized, open-label clinical trial[J]. J Clin Oncol, 2018, 36(27):2796-2803.
6
Lagergren J, Smyth E, Cunningham D, et al. Oesophageal cancer[J]. Lancet, 2017, 390(10110):2383-2396.
7
Kamarajah SK, Lin A, Tharmaraja T, et al. Risk factors and outcomes associated with anastomotic leaks following esophagectomy: a systematic review and meta-analysis[J]. Dis Esophagus, 2020, 33(3):doz089.
8
Su Q, Yin C, Liao W, et al. Anastomotic leakage and postoperative mortality in patients after esophageal cancer resection[J]. J Int Med Res, 2021, 49(9):3000605211045540.
9
Shoji Y, Takeuchi H, Fukuda K, et al. Air bubble sign: a new screening method for anastomotic leakage after esophagectomy for esophageal cancer[J]. Ann Surg Oncol, 2018, 25(4):1061-1068.
10
Goense L, Stassen PMC, Wessels FJ, et al. Diagnostic performance of a CT-based scoring system for diagnosis of anastomotic leakage after esophagectomy: comparison with subjective CT assessment[J]. Eur Radiol, 2017, 27(10):4426-4434.
11
Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG)[J]. Ann Surg, 2015, 262(2):286-294.
12
国家癌症中心,中国医师协会胸外科医师分会,中华医学会胸心血管外科学分会,等. 中国食管癌及食管胃交界部癌围手术期并发症定义及分级专家共识(2023版)[J]. 中华医学杂志2023, 103(46) : 3760-3769.
13
Cao J, Xu H, Li W, et al. Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer[J]. Curr Probl Cancer, 2021, 45(1): 100638.
14
Lidoriki I, Mylonas KS, Syllaios A, et al. The impact of nutritional and functional status on postoperative outcomes following esophageal cancer surgery[J]. Nutr Cancer, 2022, 74(8):2846-2858.
15
Jiang H, Hua R, Sun Y, et al. Risk factors for anastomotic complications after radical McKeown esophagectomy[J]. Ann Thorac Surg, 2021, 112(3):944-951.
16
Wang YJ, Xie XF, He YQ, et al. Impact of perioperative decreased serum albumin level on anastomotic leakage in esophageal squamous cell carcinoma patients treated with neoadjuvant chemotherapy followed by minimally invasive esophagectomy[J]. BMC Cancer, 2023, 23(1):1212.
17
Aoyama T, Ju M, Machida D, et al. Clinical impact of preoperative albumin-bilirubin status in esophageal cancer patients who receive curative treatment[J]. In Vivo, 2022, 36(3):1424-1431.
18
Mokart D, Merlin M, Sannini A, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery[J]. Br J Anaesth, 2005, 94(6):767-773.
19
Van Daele E, Vanommeslaeghe H, Decostere F, et al. Systemic inflammatory response and the noble and underwood (NUn) score as early predictors of anastomotic leakage after esophageal reconstructive surgery[J]. J Clin Med, 2024, 13(3):826.
20
Goense L, van Rossum PSN, Weijs TJ, et al. Aortic calcification increases the risk of anastomotic leakage after Ivor-Lewis esophagectomy[J]. Ann Thorac Surg, 2016, 102(1):247-252.
21
van Rossum PSN, Haverkamp L, Verkooijen HM, et al. Calcification of arteries supplying the gastric tube: a new risk factor for anastomotic leakage after esophageal surgery[J]. Radiology, 2015, 274(1):124-132.
22
Hoek VT, Edomskis PP, Menon AG, et al. Arterial calcification is a risk factor for anastomotic leakage after esophagectomy: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2020, 46(11):1975-1988.
23
Shimada Y, Okumura T, Nagata T, et al. Usefulness of blood supply visualization by indocyanine green fluorescence for reconstruction during esophagectomy[J]. Esophagus, 2011, 8(4):259-266.
24
Koyanagi K, Ozawa S, Oguma J, et al. Blood flow speed of the gastric conduit assessed by indocyanine green fluorescence: new predictive evaluation of anastomotic leakage after esophagectomy[J]. Medicine (Baltimore), 2016, 95(30):e4386.
25
Hong ZN, Huang L, Zhang W, et al. Indocyanine green fluorescence using in conduit reconstruction for patients with esophageal cancer to improve short-term clinical outcome: a meta-analysis[J]. Front Oncol, 2022, 12:847510.
26
李佳颐,杨森,王智弘,等. 吲哚菁绿辅助下的荧光腔镜手术在普通外科中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(2): 124-128.
27
Hirano Y, Fujita T, Konishi T, et al. Impact of pre-diabetes, well-controlled diabetes, and poorly controlled diabetes on anastomotic leakage after esophagectomy for esophageal cancer: a two-center retrospective cohort study of 1901 patients[J]. Esophagus, 2023, 20(2):246-255.
28
赵云,崔健. 食管癌术后吻合口瘘的危险因素研究[J]. 实用临床医药杂志2024, 28(1):37-40.
29
Hall BR, Flores LE, Parshall ZS, et al. Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure-targeted analysis[J]. J Surg Oncol, 2019, 120(4):661-669.
30
van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive ivor lewis versus minimally invasive Mckeown esophagectomy[J]. Ann Surg, 2020, 271(1):128-133.
31
Weiss JA, Jain S. Neoadjuvant and adjuvant therapy in esophageal cancer[J]. J Gastrointest Oncol, 2023, 14(4):1927-1932.
32
Jin Z, Zhang J, Chen 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 Esophagus, 2022, 35(9):doab089.
33
Xu J, Yan C, Li Z, et al. Efficacy and safety of neoadjuvant chemoimmunotherapy in resectable esophageal squamous cell carcinoma: a meta-analysis[J]. Ann Surg Oncol, 2023, 30(3):1597-1613.
34
Juloori A, Tucker SL, Komaki R, et al. Influence of preoperative radiation field on postoperative leak rates in esophageal cancer patients after trimodality therapy[J]. J Thorac Oncol, 2014, 9(4):534-540.
35
Zhao Z, Cheng X, Sun X, et al. Prediction model of anastomotic leakage among esophageal cancer patients after receiving an esophagectomy: machine learning approach[J]. JMIR Med Inform, 2021, 9(7):e27110.
36
Lindenmann J, Fink-Neuboeck N, Porubsky C, et al. A nomogram illustrating the probability of anastomotic leakage following cervical esophagogastrostomy[J]. Surg Endosc, 2021, 35(11):6123-6131.
37
Yu WQ, Gao HJ, Shi GD, et al. Development and validation of a nomogram to predict anastomotic leakage after esophagectomy for esophageal carcinoma[J]. J Thorac Dis, 2021, 13(6):3549-3565.
38
彭胜祖,王彬,张凯,等. 经鼻内引流治疗食管癌术后吻合口瘘伴胸腔或纵隔脓肿效果观察[J]. 肿瘤研究与临床2024, 36(11):843-846.
39
Tang H, Xue L, Hong J, et al. A method for early diagnosis and treatment of intrathoracic esophageal anastomotic leakage: prophylactic placement of a drainage tube adjacent to the anastomosis[J]. J Gastrointest Surg, 2012, 16(4):722-727.
40
黄可南,徐志飞,丁新宇,等. 吻合口旁预置负压引流管治疗食管癌术后吻合口瘘的临床对比分析[J]. 第二军医大学学报2015, 36(12): 1356-1359
41
Carter TS, Philips P, Egger M, et al. Outcomes of esophageal stent therapy for the management of anastomotic leaks[J]. Ann Surg Oncol, 2021, 28(9):4960-4966.
42
Hoeppner J, Kulemann B, Seifert G, et al. Covered self-expanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses[J]. Surg Endosc, 2014, 28(5):1703-1711.
43
Palmes D, Kebschull L, Bahde R, et al. Management of nonmalignant tracheo-and bronchoesophageal fistula after esophagectomy[J]. Thorac Cardiovasc Surg, 2021, 69(3):216-222.
44
Schweigert M, Dubecz A, Stadlhuber RJ, et al. Risk of stent-related aortic erosion after endoscopic stent insertion for intrathoracic anastomotic leaks after esophagectomy[J]. Ann Thorac Surg, 2011, 92(2):513-518.
45
Bianchi Cardona A, Hidalgo Grau LA, Feliu Canaleta J, et al. Postoperative cervical anastomotic fistula treated with a biologic glue[J]. Eur J Surg Oncol, 2005, 31(10):1222-1223.
46
Böhm G, Mossdorf A, Klink C, et al. Treatment algorithm for postoperative upper gastrointestinal fistulas and leaks using combined vicryl plug and fibrin glue[J]. Endoscopy, 2010, 42(7):599-602.
47
Tashiro K, Takeno S, Kawano F, et al. Endoscopic filling with polyglycolic acid sheets and fibrin glue of persistent fistula after esophagectomy[J]. Endoscopy, 2021, 53(3):288-292.
48
Rodella L, Laterza E, De Manzoni G, et al. Endoscopic clipping of anastomotic leakages in esophagogastric surgery[J]. Endoscopy, 1998, 30(5):453-456.
49
Honegger C, Valli PV, Wiegand N, et al. Establishment of Over-The-Scope-Clips (OTSC?) in daily endoscopic routine[J]. United European Gastroenterol J, 2017, 5(2):247-254.
50
Haito-Chavez Y, Law JK, Kratt T, et al. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video)[J]. Gastrointest Endosc, 2014, 80(4):610-622.
51
Zolotarevsky E, Kwon Y, Bains M, et al. Esophagobronchial fistula closure using a novel endoscopic over-the-scope-clip[J]. Ann Thorac Surg, 2012, 94(3):e69-e70.
52
Gubler C, Bauerfeind P. Successful closure of an esophagopericardial fistula with an over-the-scope clip[J]. Endoscopy, 2012, 44 Suppl 2 UCTN:E194-5.
53
Yip HC, Chiu PW, Chan SM, et al. Esophageal leakage after surgical repair of spontaneous rupture: successful closure with endoscopic suture device[J]. Endoscopy, 2016, 48(S 01):E344-E345.
54
Ge PS, Thompson CC. The use of the overstitch to close perforations and fistulas[J]. Gastrointest Endosc Clin N Am, 2020, 30(1):147-161.
55
Bludau M, Fuchs HF, Herbold T, et al. Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks[J]. Surg Endosc, 2018, 32(4):1906-1914.
56
Rausa E, Asti E, Aiolfi A, et al. Comparison of endoscopic vacuum therapy versus endoscopic stenting for esophageal leaks: systematic review and meta-analysis[J]. Dis Esophagus, 2018, 31(11).
57
Scognamiglio P, Reeh M, Karstens K, et al. Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: systematic review and meta-analysis[J]. Endoscopy, 2020, 52(8):632-642.
58
Hummel R, Bausch D. Anastomotic leakage after upper gastrointestinal surgery: surgical treatment[J]. Visc Med, 2017, 33(3):207-211.
59
Narita K, Iwanami H, Ikeda N, et al. A successfully treated case of empyema with a large tracheal fistula after a radical operation of esophageal cancer by fixation and plombage with major pectoral muscle flap[J]. Nihon Kyobu Geka Gakkai Zasshi, 1992, 40(8):1254-1260.
60
Nardella JE, Van Raemdonck D, Piessevaux H, et al. Gastro-tracheal fistula--unusual and life threatening complication after esophagectomy for cancer: a case report[J]. J Cardiothorac Surg, 2009, 4:69.
61
Arimoto J, Hatada A, Kawago M, et al. Closure of esophagotracheal fistula after esophagectomy for esophageal cancer[J]. Gen Thorac Cardiovasc Surg, 2015, 63(11):636-639.
62
Song SW, Lee HS, Kim MS, et al. Repair of gastrotracheal fistula with a pedicled pericardial flap after Ivor Lewis esophagogastrectomy for esophageal cancer[J]. J Thorac Cardiovasc Surg, 2006, 132(3):716-717.
63
Wang C, Yang X, Zhao J, et al. Postesophagectomy airway-gastric fistula successfully treated with subcutaneous fascia flap, tracheal reconstruction, and gastric fistula drainage: A case report and literature review[J]. J Cancer Res Ther, 2016, 12(Supplement):C225-C227.
64
Molina-Navarro C, Hosking SW, Hayward SJ, et al. Gastroaortic fistula as an early complication of esophagectomy[J]. Ann Thorac Surg, 2001, 72(5):1783-1788.
65
Kawamoto S, Sato M, Motoyoshi N, et al. Outcomes of a staged surgical treatment strategy for aortoesophageal fistula[J]. Gen Thorac Cardiovasc Surg, 2015, 63(3):147-152.
66
Xu R, Fang X, Wu S, et al. Development and prospect of esophageal tissue engineering[J]. Front Bioeng Biotechnol, 2022, 10:853193.
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