PDF(Pubmed)
Abstract：
Background and Objectives: Anastomotic insufficiencies (AI) and perforations of the upper gastrointestinal tract (uGIT) result in high morbidity and mortality. Endoscopic stent placement and endoluminal vacuum therapy (EVT) have been established as surgical revision treatment options. The Eso-Sponge® is the only licensed EVT system with limitations in treating small defects (<10 mm). Therefore, a fistula sponge (FS) was developed for the treatment of such defects as a new therapeutic approach. The aim of this study was to evaluate both EVT options\' indications, success rates, and complications in a retrospective, comparative approach. Materials and Methods: Between 01/2018 and 01/2021, the clinical data of patients undergoing FS-EVT or conventional EVT (cEVT; Eso-Sponge®, Braun Melsungen, Melsungen, Germany) due to AI/perforation of the uGIT were recorded. Indication, diameter of leakage, therapeutic success, and complications during the procedure were assessed. FSs were prepared using a nasogastric tube and a porous drainage film (Suprasorb® CNP, Lohmann & Rauscher, Rengsdorf, Germany) sutured to the distal tip. Results: A total of 72 patients were included (20 FS-EVT; 52 cEVT). FS-EVT was performed in 60% suffering from AI (cEVT = 68%) and 40% from perforation (cEVT = 32%; p > 0.05). FS-EVT\'s duration was significantly shorter than cEVT (7.6 ± 12.0 d vs. 15.1 ± 14.3 d; p = 0.014). The mean diameter of the defect was 9 mm in the FS-EVT group compared to 24 mm in cEVT (p < 0.001). Therapeutic success was achieved in 90% (FS-EVT) and 91% (cEVT; p > 0.05). Conclusions: EVT comprises an efficient treatment option for transmural defects of the uGIT. In daily clinical practice, fistulas < 10 mm with large abscess formations poses a special challenge since intraluminal cEVT usually is ineffective. In these cases, the concept of extraluminal FS placement is safe and effective.
摘要：
背景和目的：吻合口不足（AI）和上消化道穿孔（uGIT）导致高发病率和死亡率。内窥镜支架放置和腔内真空治疗（EVT）已被确定为手术翻修治疗方案。Eso-Sponge®是唯一获得许可的EVT系统，在处理小缺陷（<10mm）方面存在局限性。因此,开发了瘘管海绵（FS）作为一种新的治疗方法，用于治疗此类缺陷。这项研究的目的是评估两种EVT选项的适应症，成功率,和并发症的回顾性研究，比较法。材料与方法：2018年1月1日至2021年1月，接受FS-EVT或常规EVT（cEVT;Eso-Sponge®，BraunMelsungen,Melsungen,德国）由于记录了uGIT的AI/穿孔。指示,泄漏直径,治疗成功，并对手术期间的并发症进行了评估。FSs使用鼻胃管和多孔引流膜(Suprasorb®CNP,Lohmann&Rauscher,Rengsdorf,德国）缝合到远端。结果：共纳入72例患者（20FS-EVT；52cEVT）。FS-EVT在60％患有AI（cEVT=68％）和40％的穿孔（cEVT=32％；p>0.05）中进行。FS-EVT的持续时间明显短于cEVT（7.6±12.0dvs.15.1±14.3d；p=0.014）。FS-EVT组缺损的平均直径为9mm，cEVT为24mm（p<0.001）。治疗成功率分别为90%(FS-EVT)和91%(cEVT;p>0.05)。结论：EVT是uGIT透壁缺陷的有效治疗选择。在日常临床实践中，由于管腔内cEVT通常无效，因此具有大脓肿形成的<10mm的瘘管构成了特殊的挑战。在这些情况下,肠外FS放置的概念是安全有效的。
