食管癌和贲门癌术后胸内吻合口瘘诊治分析  

Selection of treatment for intrathoracic anastomotic leakage after resection of esophageal and gastric cardial carcinoma

作　　者：郭俊唐[1] 初向阳[1] 孙玉鹗[1] 梁朝阳[1] 周乃康[1] 刘阳[1] 王云喜[1] 

机构地区：[1]解放军总医院胸外科,北京100853

出　　处：《临床外科杂志》2012年第2期115-117,共3页Journal of Clinical Surgery

摘　　要：目的 探讨食管癌及贲门癌术后胸内吻合口瘘的诊断及治疗方法.方法 分析我院2001年1 月至2010年12月2583例行食管癌、贲门癌术后发生胸内吻合口瘘19例患者的临床资料.结果 本组吻合口瘘发生率为0.74%,死亡率15.8%.确诊时间平均术后10d.接受手术治疗9例（治愈6例）,保守治疗10例（治愈8例）.手术治疗组平均住院时间79.4d,保守治疗组为70.5 d.手术治疗组与保守治疗组在治愈率和平均住院时间方面差异均无统计学意义（P=0.09,P=0.63）.结论胸内吻合口瘘有较高死亡率.一旦确诊或高度怀疑吻合口瘘发生,应积极根据患者情况个体化选择合理的治疗方法.无论是手术治疗还是保守治疗,充分引流、有效冲洗和营养支持治疗均很重要.Objective To investigate the diagnosis and treatment of intrathoraeie anastomotie leakage after resection of esophageal carcinoma（EC） and gastric eardial carcinoma （ CC ）. Methods The clinical data of 19 patients who developed intrathoracie anastomotic leakage were evaluated retrospectively. These patients were from 2583 patients undergoing resection of EC and CC and reconstruction between January 2001 and December 2010. Results The overall incidence of intrathoracie anastomotie leakage was 0.74%. Four patients died with a mortality of 15.8%. The median time interval from operation to diagnosis of leak was 10 days. Nine patients received reoperation such as primary anastomotic repair, abscess evacuation and chest drainage, of which 6 were cured. The other 10 patients were managed nonoperatively, of which 8 were cured. Median hospitalization was 79.4 days in the reoperative group and 70.5 days in the conservative group. There was no significant difference in cure rate or median hospitalization between reoperative group and conservative group （P = 0.09, P =0.63）. Conclusion lntrathoracic anastomotic leakage is associated with high mortality. Once anastomotic leakage after resection of EC and CC is diagnosed or highly suspected, individualized strategy of management should be taken according to the condition of patient. Sufficient drainage, thorough wash and supportive care play the key roles in either way of management.

关 键 词：食管肿瘤 贲门肿瘤 吻合口瘘 

分 类 号：R735[医药卫生—肿瘤]