食管癌术后良性吻合口狭窄的研究进展

摘要/Abstract

摘要：良性吻合口狭窄是食管癌根治术后最常见的近期并发症之一，可导致患者吞咽困难和体重下降，随着病情逐渐加重，可严重影响患者术后生命质量。且病情可反复发生，需要多次接受治疗，增加患者的痛苦和额外治疗费用。良性吻合口狭窄与多种病因密切相关，可针对病因采取一定的措施预防其发生。在治疗方面扩张术是治疗良性吻合口狭窄的一线治疗方案，可联合药物予以局部治疗。内镜下切开术作为新型治疗方式，是一种有前景的治疗方案。支架置入术远期效果不佳，且有较高的移位和组织增生的风险，应权衡利弊后施行。

关键词:食管肿瘤,吞咽障碍,良性吻合口狭窄

Abstract:Benign anastomotic stricture is one of the most common complications after esophagectomy, which can result in the dysphagia and weight loss of patients. It can severely impair the patient′s quality of life with the progress of the stricture. What is more, refractory benign stricture is a major challenge for physicians and needs repeated treatments, which aggravates the patient′s pain and increases extra costs. Benign anastomotic stricture is associated closely with various risk factors, which can be prevented by adopting some measures. Dilation remains the firstline treatment to manage benign anastomotic stricture and it may be effective to combine with drug therapy. Endoscopic incisional therapy is a promising method as a new treatment therapy. The use of various stents fails to improve overall longterm dysphagiafree rate. In addition, stent has a possible risk of migration and hyperplastic tissue growth, which should be used by weighing the pros and cons.

Key words:Esophageal neoplasms,Deglutition disorders,Benign anastomotic stricture

王新宇，李春光，陈和忠. 食管癌术后良性吻合口狭窄的研究进展[J]. 国际肿瘤学杂志, 2019, 46(3): 186-190.

Wang Xinyu, Li Chunguang, Chen Hezhong. Research progress of benign anastomotic stricture after esophagectomy[J]. Journal of International Oncology, 2019, 46(3): 186-190.

参考文献

［1］ Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018［J］. CA Cancer J Clin, 2018, 68(1): 730. DOI: 10.3322/caac.21442. ［2］ Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015［J］. CA Cancer J Clin, 2016, 66(2): 115132. DOI: 10.3322/caac.21338. ［3］ Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 200014 (CONCORD3): analysis of individual records for 37513025 patients diagnosed with one of 18 cancers from 322 populationbased registries in 71 countries［J］. Lancet, 2018, 391(10125): 10231075. DOI: 10.1016/S01406736(17)333263. ［4］ Haverkamp L, van der Sluis PC, Verhage RJ, et al. Endtoend cervical esophagogastric anastomoses are associated with a higher number of strictures compared with endtoside anastomoses ［J］. J Gastrointest Surg, 2013, 17(5): 872876. DOI: 10.1007/s1160501321598. ［5］ Price TN, Nichols FC, Harmsen WS, et al. Comprehensive review of anastomotic technique in 432 esophagectomies ［J］. Ann Thorac Surg, 2013, 95(4): 11541160. DOI: 10.1016/j.athoracsur.2012.11.045. ［6］ Honda M, Kuriyama A, Noma H, et al. Handsewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and metaanalysis［J］. Ann Surg, 2013, 257(2): 238248. DOI: 10.1097/SLA.0b013e31826d4723. ［7］ Huang Q, Zhong J, Yang T, et al. Impacts of anastomotic complications on the healthrelated quality of life after esophagectomy［J］. J Surg Oncol, 2015, 111(4): 365370. DOI: 10.1002/jso.23837. ［8］ Williams VA, Watson TJ, Zhovtis S, et al. Endoscopic and symptomatic assessment of anastomotic strictures following esophagectomy and cervical esophagogastrostomy［J］. Surg Endosc, 2008, 22(6): 14701476. DOI: 10.1007/s0046400796536. ［9］ van Halsema EE, Noordzij IC, van Berge Henegouwen MI, et al. Endoscopic dilation of benign esophageal anastomotic strictures over 16 mm has a longer lasting effect［J］. Surg Endosc, 2017, 31(4): 18711881. DOI: 10.1007/s0046401651870. ［10］ van Heijl M, Gooszen JA, Fockens P, et al. Risk factors for development of benign cervical strictures after esophagectomy［J］. Ann Surg, 2010, 251(6): 10641069. DOI: 10.1097/SLA.0b013e3181deb4b7. ［11］ Tanaka K, Makino T, Yamasaki M, et al. An analysis of the risk factors of anastomotic stricture after esophagectomy［J］. Surg Today, 2017, 48(4): 16. DOI: 10.1007/s0059501716085. ［12］ Ahmed Z, Elliott JA, King S, et al. Risk factors for anastomotic stricture postesophagectomy with a standardized sutured anastomosis［J］. World J Surg, 2017, 41(2): 487497. DOI: 10.1007/ s0026801637460. ［13］ Knezevic JD, Radovanovic NS, Simic AP, et al. Colon interposition in the treatment of esophageal caustic strictures: 40 years of experience［J］. Dis Esophagus, 2007, 20(6): 530534. DOI: 10.1111/j.14422050.2007.00694.x. ［14］ Lerut T, Coosemans W, Decker G, et al. Anastomotic complications after esophagectomy［J］. Dig Surg, 2002, 19(2): 9298. DOI: 10.1159/000052018. ［15］ Rice TW. Anastomotic stricture complicating esophagectomy［J］. Thorac Surg Clin, 2006, 16(1): 6373. DOI: 10.1016/j.thorsurg.2006.02.002. ［16］ Deng XF, Liu QX, Zhou D, et al. Handsewn vs linearly stapled esophagogastric anastomosis for esophageal cancer: a metaanalysis［J］. World J Gastroenterol, 2015, 21(15): 47574764. DOI: 10.3748/wjg.v21.i15.4757. ［17］ Liu QX, Min JX, Deng XF, et al. Is hand sewing comparable with stapling for anastomotic leakage after esophagectomy? A metaanalysis［J］. World J Gastroenterol, 2014, 20(45): 1721817226. DOI: 10.3748/wjg.v20.i45.17218. ［18］ Nishikawa K, Fujita T, Yuda M, et al. Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy［J］. Surgery, 2016, 160(5): 12941301. DOI: 10.1016/j.surg.2016.06.022. ［19］ Johansson J, Oberg S, Wenner J, et al. Impact of proton pump inhibitors on benign anastomotic stricture formations after esophagectomy and gastric tube reconstruction: results from a randomized clinical trial［J］. Ann Surg, 2009, 250(5): 667673. DOI: 10.1097/SLA.0b013e3181bcb139. ［20］ Shimada Y, Okamura 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. DOI: 10.1007/s1038801102917. ［21］ 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. DOI: 10.1097/MD.0000000000004386. ［22］ Noma K, Shirakawa Y, Kanaya N, et al. Visualized evaluation of blood flow to the gastric conduit and complications in esophageal reconstruction［J］. J Am Coll Surg, 2018, 226(3): 241251. DOI: 10.1016/j.jamcollsurg.2017.11.007. ［23］ Hanaoka N, Ishihara R, Motoori M, et al. Endoscopic balloon dilation followed by intralesional steroid injection for anastomotic strictures after esophagectomy: a randomized controlled trial［J］. Am J Gastroenterol, 2018, 113(10): 14681474. DOI: 10.1038/s413950180253y. ［24］ Ramage JI Jr, Rumalla A, Baron TH, et al. A prospective, randomized, doubleblind, placebocontrolled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures［J］. Am J Gastroenterol, 2005, 100(11): 24192425. DOI: 10.1111/j.15720241.2005.00331.x. ［25］ PereiraLima JC, Lemos Bonotto M, Hahn GD, et al. A prospective randomized trial of intralesional triamcinolone injections after endoscopic dilation for complex esophagogastric anastomotic strictures: steroid injection after endoscopic dilation［J］. Surg Endosc, 2015, 29(5): 11561160. DOI: 10.1007/s0046401437816. ［26］ Hirdes MM, van Hooft JE, Koornstra JJ, et al. Endoscopic corticosteroid injections do not reduce dysphagia after endoscopic dilation therapy in patients with benign esophagogastric anastomotic strictures［J］. Clin Gastroenterol Hepatol, 2013, 11(7): 795801. DOI: 10.1016/j.cgh.2013.01.016. ［27］ ElAsmar KM, Hassan MA, Abdelkader HM, et al. Topical mitomycin C application is effective in management of localized caustic esophageal stricture: a doubleblinded, randomized, placebocontrolled trial［J］. J Pediatr Surg, 2013, 48(7): 16211627. DOI: 10.1016/j.jpedsurg.2013.04.014. ［28］ Machida H, Tominaga K, Minamino H, et al. Locoregional mitomycin C injection for esophageal stricture after endoscopic submucosal dissection［J］. Endoscopy, 2012, 44(6): 622625. DOI: 10.1055/s00321306775. ［29］ Nagaich N, Nijhawan S, Katiyar P, et al. MitomycinC: ′a ray of hope′ in refractory corrosive esophageal strictures［J］. Dis Esophagus, 2014, 27(3): 203205. DOI: 10.1111/dote.12092. ［30］ Baird R, Laberge JM, Lévesque D. Anastomotic stricture after esophageal atresia repair: a critical review of recent literature［J］. Eur J Pediatr Surg, 2013, 23(3): 204213. DOI: 10.1055/s00331347917. ［31］ Muto M, Ezoe Y, Yano T, et al. Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture (with video)［J］. Gastrointest Endosc, 2012, 75(5): 965972. DOI: 10.1016/j.gie.2012.01.012. ［32］ Jayanta S, Narendra D, Saroj Kant S, et al. Endoscopic incisional therapy for benign esophageal strictures: technique and results［J］. World J Gastrointest Endosc, 2015, 7(19): 13181326. DOI: 10.4253/wjge.v7.i19.1318. ［33］ Lee TH, Lee SH, Park JY, et al. Primary incisional therapy with a modified method for patients with benign anastomotic esophageal stricture［J］. Gastrointest Endosc, 2009, 69(6): 10291033. DOI: 10.1016/j.gie.2008.07.018. ［34］邱敏霞, 赵心恺, 陈文妹, 等. 内镜下环周切开术治疗食管吻合口良性狭窄临床疗效观察［J］. 中华胃肠内镜电子杂志, 2017(2): 6163. DOI: 10.3877/cma.j.issn.20957157.2017.02.004. ［35］张震, 张轶群, 陈巍峰, 等. 内镜下放射状切开治疗食管吻合口良性狭窄的临床初探［J］. 中华消化内镜杂志, 2016, 33(4): 208210. DOI: 10.3760/cma.j.issn.10075232.2016.04.002. ［36］ Tan Y, Lv L, Duan T, et al. Endoscopic incision and selective cutting for the treatment of refractory colorectal anastomotic strictures［J］. Int J Colorectal Dis, 2016, 31(5): 10631064. DOI: 10.1007/s0038401523855. ［37］ Park JY, Song HY, Kim JH, et al. Benign anastomotic strictures after esophagectomy: longterm effectiveness of balloon dilation and factors affecting recurrence in 155 patients［J］. AJR Am J Roentgenol, 2012, 198(5): 12081213. DOI: 10.2214/AJR.11.7608. ［38］ Standards of Practice Committee, Egan JV, Baron TH, et al. Esophageal dilation［J］. Gastrointest Endosc, 2006, 63(6): 755760. DOI: 10.1016/j.gie.2006.02.031. ［39］ Grooteman KV, Wong Kee Song LM, Vleggaar FP, et al. Nonadherence to the rule of 3 does not increase the risk of adverse events in esophageal dilation［J］. Gastrointest Endosc, 2017, 85(2): 332337. DOI: 10.1016/j.gie.2016.07.062. ［40］ Hirdes MM, Vleggaar FP, Siersema PD. Stent placement for esophageal strictures: an update［J］. Expert Rev Med Devices, 2011, 8(6): 733755. DOI: 10.1586/erd.11.44. ［41］ Poincloux L, Rouquette O, Abergel A. Endoscopic treatment of benign esophageal strictures: a literature review［J］. Expert Rev Gastroenterol Hepatol, 2017, 11(1): 5364. DOI: 10.1080/17474124.2017.1260002.

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