腔内负压辅助闭合技术治疗食管空肠吻合口漏的疗效与安全性：21例回顾性分析（附视频）

Efficacy and safety of endoluminal vacuum-assisted closure for esophagojejunal anastomotic leakage: a retrospective analysis of 21 cases (with video)

摘要:

背景与目的 食管空肠吻合口漏是全胃切除术后严重并发症之一，可导致腹腔及纵隔感染，甚至危及生命。腔内负压辅助闭合（EVAC）技术近年来被应用于消化道漏的微创治疗，但其在食管空肠吻合口漏中的临床证据仍有限。本研究旨在评估EVAC治疗食管空肠吻合口漏的临床疗效与安全性。方法 回顾性分析2022年1月—2025年7月江阴市人民医院采用EVAC治疗的21例食管空肠吻合口漏患者的临床资料。所有患者均经内镜或影像学确诊，并在内镜引导下置入自制EVAC装置。观察技术成功率、漏口闭合率、EVAC治疗时间、漏口愈合时间、住院时间及治疗前后炎症指标变化，并评估治疗相关并发症及长期随访结果。结果 21例患者均顺利完成EVAC置入及负压治疗，技术成功率为100%。18例患者实现漏口闭合，闭合率为85.7%。患者平均EVAC治疗时间为（15.8±8.2）d，平均漏口愈合时间为（19.1±9.4）d，中位住院时间为27（25~49）d。治疗后白细胞计数及C-反应蛋白水平均较治疗前明显下降（均P<0.05）。治疗期间未发生消化道大出血、消化道狭窄、异物残留等严重并发症。平均随访（22.4±12.6）个月，未见吻合口漏复发、消化道狭窄或新发脓肿形成。结论 EVAC治疗食管空肠吻合口漏具有较高的技术成功率和漏口闭合率，能够有效控制感染并促进漏口愈合，且安全性良好，可作为食管空肠吻合口漏的重要微创治疗选择。

Abstract:

Background and Aims Esophagojejunal anastomotic leakage is one of the most severe complications after total gastrectomy and may lead to intra-abdominal or mediastinal infection with high mortality. Endoluminal vacuum-assisted closure (EVAC) has recently emerged as a minimally invasive treatment for gastrointestinal leaks; however, evidence regarding its application in esophagojejunal anastomotic leakage remains limited. This study aimed to evaluate the efficacy and safety of EVAC in the treatment of esophagojejunal anastomotic leakage.Methods Clinical data of 21 patients with esophagojejunal anastomotic leakage treated with EVAC at Jiangyin People's Hospital between January 2022 and July 2025 were retrospectively analyzed. All patients were diagnosed by endoscopy or imaging examinations and underwent placement of a self-made EVAC device under endoscopic guidance. Technical success rate, fistula closure rate, duration of EVAC therapy, healing time, length of hospital stay, changes in inflammatory markers, treatment-related complications, and long-term outcomes were evaluated.Results All 21 patients successfully underwent EVAC placement and negative-pressure therapy, with a technical success rate of 100%. Fistula closure was achieved in 18 patients, yielding a closure rate of 85.7%. The mean duration of EVAC therapy was (15.8±8.2) d, and the mean healing time was (19.1±9.4) d. The median postoperative hospital stay was 27 (25-49) d. White blood cell count and C-reactive protein levels were significantly reduced after treatment compared with pre-treatment values (both P<0.05). No severe treatment-related complications, including major gastrointestinal bleeding, stenosis, or foreign body retention, were observed. During a mean follow-up of (22.4±12.6) months, no recurrence of anastomotic leakage, gastrointestinal stenosis, or newly developed abscess was detected.Conclusion EVAC is an effective and safe minimally invasive treatment for esophagojejunal anastomotic leakage, with high technical success and fistula closure rates. It can effectively control infection and promote fistula healing, making it an important therapeutic option for this complication.