RESUMEN
Complications following esophagectomy significantly affect the outcome, including perioperative mortality, costs and survival. Pulmonary complications and anastomotic leaks still remain the most serious complications and early recognition and appropriate initial treatment are essential. Mortality associated with esophageal leaks is decreasing due in part to the increased use of computed tomography (CT) scanning and endoscopy for diagnosis and subsequent appropriate multidisciplinary therapy. In this respect, it is critically important to differentiate between leaks and conduit necrosis, and endoscopic examination is the best method for making this assessment. Endoscopic and interventional radiology techniques are being applied increasingly for detection of intrathoracic leaks but appropriate patient selection is important. Adequate external drainage of the leak and prevention of further contamination are the primary therapeutic goals. The spectrum of therapeutic options ranges from simple conservative treatment for smaller, well drained leaks, interventional placement of drains, to endoscopic intervention with closure of the fistula or placement of stents and reoperation or discontinuity resection for conduit necrosis.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Complicaciones Posoperatorias/cirugía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Anastomosis Quirúrgica/métodos , Fuga Anastomótica/diagnóstico , Fuga Anastomótica/mortalidad , Fuga Anastomótica/cirugía , Causas de Muerte , Drenaje , Endoscopía , Fístula Esofágica/diagnóstico , Fístula Esofágica/mortalidad , Fístula Esofágica/cirugía , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidad , Hernia Hiatal/diagnóstico , Hernia Hiatal/mortalidad , Hernia Hiatal/cirugía , Humanos , Neumonía/diagnóstico , Neumonía/prevención & control , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidad , Pronóstico , Radiología Intervencionista , Reoperación/métodos , Stents , Estómago/cirugía , Tasa de Supervivencia , Tomografía Computarizada por Rayos XRESUMEN
Difficult wounds of different origin are a challenge for medical and custodial knowledge and capability. They are often characterised by a complex and protracted course of disease and cause considerable costs. Critical wounds particularly include chronic wounds such as venous stasis ulcers, diabetic foot ulcers or pressure ulcers and often lead to physical and psychosocial strain. Large-scale and deep wounds, wounds in traumatised tissue, wound complications and infections as well as wounds in patients with severe accompanying diseases or in patients of old age are often marked by a severe and unpredictable course and are therefore a threat for patients. Knowledge of characteristic symptoms and particularities of the course of disease are essential for early diagnosis and succsessful treatment. Despite many recent advances in wound care the management is often compounded by a lack of clearly defined, comprehensive wound care standards.