Navigating complexities and considerations for suspected anastomotic leakage in the upper gastrointestinal tract: A state of the art review

IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
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引用次数: 0

Abstract

This state-of-the-art review explores the intricacies of anastomotic leaks following oesophagectomy and gastrectomy, crucial surgeries for globally increasing esophageal and gastric cancers. Despite advancements, anastomotic leaks occur in up to 30 % and 10 % of oesophagectomy and gastrectomy cases, respectively, leading to prolonged hospital stays, substantial impact upon short- and long-term health-related quality of life and greater mortality. Recognising factors contributing to leaks, including patient characteristics and surgical techniques, are vital for preoperative risk stratification. Diagnosis is challenging, involving clinical signs, biochemical markers, and various imaging modalities. Management strategies range from non-invasive approaches, including antibiotic therapy and nutritional support, to endoscopic interventions such as stent placement and emerging vacuum-assisted closure devices, and surgical interventions, necessitating timely recognition and tailored interventions. A step-up approach, beginning non-invasively and progressing based on treatment success, is more commonly advocated. This comprehensive review highlights the absence of standardised treatment algorithms, emphasizing the importance of individualised patient-specific management.

上消化道疑似吻合口漏的复杂性和注意事项:最新进展综述
食管切除术和胃切除术是治疗全球日益增多的食管癌和胃癌的关键手术,这篇最新综述探讨了食管切除术和胃切除术后吻合口漏的复杂性。尽管医疗技术不断进步,但在食道切除术和胃切除术病例中,吻合口漏的发生率分别高达 30% 和 10%,导致住院时间延长、短期和长期健康相关生活质量受到严重影响以及死亡率升高。认识导致渗漏的因素,包括患者特征和手术技术,对于术前风险分层至关重要。诊断具有挑战性,涉及临床症状、生化指标和各种成像模式。管理策略包括非侵入性方法(包括抗生素治疗和营养支持)、内窥镜干预(如支架置入和新出现的真空辅助闭合装置)和外科干预,因此必须及时识别并采取有针对性的干预措施。目前更普遍提倡的是一种循序渐进的方法,即从非侵入性治疗开始,根据治疗效果逐步推进。这篇综合评论强调了标准化治疗算法的缺乏,强调了针对患者个体化管理的重要性。
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来源期刊
CiteScore
5.50
自引率
0.00%
发文量
23
审稿时长
69 days
期刊介绍: Each topic-based issue of Best Practice & Research Clinical Gastroenterology will provide a comprehensive review of current clinical practice and thinking within the specialty of gastroenterology.
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