胃癌切除术后胃肠道瘘的治疗  

Gastrointestinal leakage after gastrectomy for gastric cancer

作　　者：唐云[1] 李荣[1] 陈凛[1] 卫勃[1] 武现生[1] 

机构地区：[1]解放军总医院普外科,北京100853

出　　处：《中华普通外科杂志》2010年第3期205-208,共4页Chinese Journal of General Surgery

摘　　要：目的总结胃癌切除术后胃肠道瘘的治疗经验，以提高对胃癌切除术后胃肠道瘘的治疗水平。方法对1997年1月至2006年12月在北京解放军总医院治疗的胃癌切除术后19例吻合口瘘和18例十二指肠残端瘘共37例胃肠道瘘患者进行回顾性分析。结果本组37例均加强了瘘口附近的腹腔引流，采用了持续胃肠减压，先给予肠外营养支持、然后从肠外营养支持逐步过渡到肠内营养支持的治疗手段。32例在肠外营养液中强化了谷氨酰胺，31例使用了生长抑素，13例在吻合口瘘愈合期加用了生长激素。9例瘘口于术后21～30d自愈，24例于30～60d内愈合，2例于60～81d内愈合。2例死亡，其中1例食管空肠吻合口瘘因严重的左侧胸腔、肺部感染及腹腔感染于术后42d死亡，另1例十二指肠残端瘘因瘘口周围严重感染和急性腹腔内出血于术后62d死亡。结论保证腹腔引流的通畅、持续胃肠减压，特别是肠外结合肠内营养支持、强化谷氨酰胺、生长抑素及生长激素等措施，是促进胃癌切除术后胃肠道瘘愈合的重要手段。Objective To summarize the treatment experiences in gastrointestinal leakage after gastreetomy for gastric cancer. Mehods From January 1997 to December 2006 the clinical data of 37 cases of gastrointestinal leakage including anastomotic leakage in 19 cases and duodenal stump leakage in 18 after gastrectomy for gastric cancer in People＇s Liberation Army General Hospital were analyzed retrospectively. Results All of the cases were treated with abdominal drainage, continuous gastrointestinal decompression and parenteral nutrition combined with enteral nutrition. There were 32 cases receiving glutamine enrichment nutrition support, 31 cases used somatostatin, 13 cases received supplemented recombinant human growth hormone. Fistula healed in 21 -30 d in 9 cases after gastrectomy, in the other 24 cases fistula healed in 30 - 60 d, while it healed in 60 - 81 d in the remaining 2 cases. Two died of leakage associated complications after gastrectomy for gastric cancer including anastomotie leakage following esophagojejunostomy complicated by severe thoracic and lung infection in one and duodenal stump leakage complicated by severe abdominal cavity sepsis and hemorrhage in the other. Conclusion Patent and effective abdominal cavity drainage, continuous gastrointestinal decompression, parenteral nutrition combined with enteral nutrition, glutamine, somatostatin and recombinant human growth hormone are the important factors for the healing of gastrointestinal leakage after gastreetomy for gastric cancer.

关 键 词：胃肿瘤 胃瘘 肠瘘 胃切除术 营养支持 

分 类 号：R735.2[医药卫生—肿瘤]