近端胃切除术术后发生食管胃吻合口漏合并纵隔脓肿时，处理重点不仅是封堵漏口或引流胸腔积液，更在于及时控制吻合口旁纵隔感染源。对于漏口清晰、漏口与局限性纵隔脓腔相通、单纯胸腔引流或保守治疗难以充分控制感染的病人，胃镜直视下经漏口置管可作为一种直接的纵隔感染源控制路径。该技术的关键在于术前影像规划、低阻力轻柔置管、充分外引流、动态冲洗管理及严格管路核对。

For esophagogastric anastomotic leakage complicated with mediastinal abscess after proximal gastrectomy, management should focus not only on leak closure or drainage of pleural effusion, but more importantly on timely control of the mediastinal infection source adjacent to the anastomosis. Endoscopic trans-fistula catheter drainage may provide a direct route for mediastinal source control in selected patients with a clearly identified defect communicating with a localized mediastinal abscess, especially when conservative treatment or pleural drainage alone is insufficient. Careful preprocedural imaging, gentle low-resistance catheter placement, adequate external drainage, dynamic irrigation management, and strict tube identification are essential for this technique.