背景：空肠吻合术广泛用于食道切除术后的肠内营养（EN）；然而，其风险和收益仍然存在争议。我们旨在评估接受食管鳞状细胞癌（ESCC）食管切除术的患者的空肠管（FJT）的短期和长期结局，这些患者被认为是吻合口漏的高风险。
方法：我们回顾性分析了716例食管癌患者（FJT组，n=68)或无(对照组，n=648)术中放置FJT。使用倾向得分匹配(PSM)来调整混杂因素。PSM后确定每位患者吻合口漏的风险水平。
结果：FJT组患者发生吻合口漏的风险更高（14.9%vs.11.3%），术后并发症的增加无统计学意义[31.3%vs.21.8%,优势比(OR)=1.139，95%置信区间(CI)，在PSM后0.947-1.370,P=0.141]。医疗支出,术后住院时间,FJT组和对照组的短期死亡率相似。FJT的放置似乎加速了吻合口漏的恢复（27.2vs.37.4d,P=0.073)。FJT组患者在[风险比（HR）=0.850，P=0.390]和PSM后（HR=0.797，P=0.292）的总生存期（OS）相当。
结论：FJT显示出可接受的安全性以及对吻合口漏高推测风险的ESCC患者的潜在益处。虽然FJT不会影响操作系统，应考虑在食管切除术患者中放置FJT，并根据患者的渗漏风险状况针对个体患者进行调整。
BACKGROUND: Feeding jejunostomy is widely used for enteral nutrition (EN) after esophagectomy; however, its risks and benefits are still controversial. We aimed to evaluate the short-term and long-term outcomes of feeding jejunal tube (FJT) in patients undergoing esophagectomy for esophageal squamous cell carcinoma (ESCC) who were deemed high-risk for anastomotic leakage.
METHODS: We retrospectively analyzed 716 patients who underwent esophagectomy with (FJT group, n=68) or without (control group, n=648) intraoperative placement of FJT. Propensity score matching (PSM) was used for the adjustment of confounding factors. Risk level for anastomotic leakage was determined for every patient after PSM.
RESULTS: Patients in the FJT group were at higher risk of anastomotic leakage (14.9% vs. 11.3%), and had a statistically non-significant increase of postoperative complications [31.3% vs. 21.8%, odds ratio (OR) =1.139, 95% confidence interval (CI), 0.947-1.370, P=0.141] after PSM. Medical expenditure, length of postoperative hospital stay, and short-term mortality were similar between the FJT and control groups. Placement of FJT appeared to accelerate the recovery of anastomotic leakage (27.2 vs. 37.4 d, P=0.073). Patients in FJT group achieved comparable overall survival (OS) both before [hazard ratio (HR) =0.850, P=0.390] and after (HR =0.797, P=0.292) PSM.
CONCLUSIONS: FJT showed acceptable safety profile along with potential benefits for ESCC patients with a high presumed risk of anastomotic leakage. While FJT does not impact OS, placement of FJT should be considered in esophagectomy patients and tailored to individual patients based on their leak-risk profile.
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