食管贲门癌术后早期胸内消化道瘘外科诊治体会  

Surgical treatment for fistula of thoracic anastomasis in early stage postoperation of esophageal and cardiac cancer

作　　者：乔宇峰[1] 于振涛[1] 任鹏[1] 刘向明[1] 屈大望[1] 

机构地区：[1]天津医科大学附属肿瘤医院食管肿瘤科天津市"肿瘤防治"重点实验室,天津300060

出　　处：《实用肿瘤杂志》2010年第3期315-318,共4页Journal of Practical Oncology

摘　　要：目的观察食管贲门癌术后早期胸内消化道瘘的临床表现,探讨应用二次开胸手术治疗胸内消化道瘘的手术适应证及治疗体会。方法食管贲门癌根治术后早期胸内消化道瘘病例6例,均采用二次开胸,充分冲洗胸腔,根据瘘道情况采取切除瘘道二次吻合重建消化道或者手工浆肌层修补瘘道方法缝合胸内消化道瘘。术后密切观察胸腔引流液颜色性状,保持胃肠减压、胸腔引流通畅,加强抗感染,延长术后禁食时间。结果6例术中见瘘口周围水肿,感染不严重,胃食管主要供血血管无明显损伤,重新吻合或窦道修补成功完成,术后未出现二次胸内消化道瘘,其中5例治愈出院,1例因呼吸功能衰竭于术后第8天死亡。结论食管贲门癌根治术后早期胸内消化道瘘通过二次开胸修补或切除瘘道二次吻合重建消化道方法可迅速去除病因,阻断感染、中毒、电解质平衡紊乱及其他相关并发症发生,疗效确切。故早期胸内消化道瘘外科治疗优于保守内科治疗。Objective To observe the digestive tract esophageal and cardiac carcinoma postoperative clinical manifestations of early intrathoracic digestive tract fistula and to explore the application of secondary treatment of thoracic and thoracic surgery within the digestive tract fistula surgical indications as well as treatment experience.Methods Six cases of intrathoracic fistulas were studied and reported.Secondary thoracotomy was applied,fully rinsing the chest,the digestive tract was reconstructed according to the condition of fistula with secondary fistula resection anastomosis or fistula repair manual method of muscle plasma to suture intrathoracic digestive tract fistula.After surgery,pleural drainage fluid color traits were closely observed,maintaining decompression,keeping chest drainage unobstructed,strengthening anti-infection and extending postoperative fasting time.Results Edema was observed around the fistula,infections were not severe in all 6 cases during operation.There was no significant damage within the main blood vessels supplying the gastro-esophageal.Reanastomosis or sinus repair was accomplished.Secondary intrathoracic digestive tract fistulachest did not occur.Among 6 cases,5 were healed and discarged,1 case died on the 8th day after operation due to respiratory failure.Conclusions Early treatment of intrathoracic digestive tract fistula with the method of repairing fistula by secondary thoracotomy or reconstructing the digestive tract by fistula resection can quickly remove the causes,block infection,poisoning,electrolyte balance disorders and other related complications.The curative effect is assured.Therefore,early surgical treatment of intrathoracic digestive tract fistula is superior to conservative medical treatment.

关 键 词：食管肿瘤 胃肿瘤 贲门 消化系统瘘 吻合术 外科 

分 类 号：R735[医药卫生—肿瘤]