内镜下食管周围纵隔脓肿清创术:一项前瞻性序列病例研究

摘要

cqvip:Background: Mediastinal abscesses after esophageal perforation or postoperative leakage nearly always require surgical intervention. Methods: Patients with paraesophageal abscesses were treated with EUS- guided or endoscopic mediastinal puncture if the abscess was >2 cm and sepsis was present. Abscess cavities were entered with a 9.5- mm endoscope after balloon dilation to allow irrigation and drainage. Debris was removed with a Dormia basket. Concomitant pleural effusions were treated with transthoracic drains. Patients received intravenous antibiotics and enteral/parenteral nutrition. Results: Twenty patients fulfilled the entry criteria. Simple drainage was sufficient in 4 cases, and puncture was impossible in one case. Of the 15 treated patients (age 39- 76 years, 5 women) the etiology of perforation was Boerhaave’ s syndrome (n = 8), anastomotic leak (n = 3), and iatrogenic perforation (n = 4). Debridement was successful in all cases and required a median of 5 daily sessions (range 3- 10). All patients became apyrexial, with a Creactive protein< 5 mg/L within a median of 4 days (range 2- 8 days). Esophageal defects were closed with endoclips (n = 7), fibrin glue (n = 4), metal stents (n = 1), or spontaneously healed (n = 3). One patient died from a massive pulmonary embolism one day after successful debridement (mortality 7% ). No other complications were seen. Median follow- up was 12 months (range 3- 40 mon- ths). Conclusions: Nonoperative endoscopic transesophag- eal debridement of mediastinal abscesses appears safe and effective.