胃癌根治术后发生吻合口漏或十二指肠残端漏的保守治疗  

Conservative Treatment for Anastomotic Leakage and Duodenal Stump Leakage after Radical Resection of Gastric Carcinoma

作　　者：唐卫[1,2] 左朝晖 欧阳永忠[1,2] 汤明 

机构地区：[1]湖南省肿瘤医院 [2]中南大学湘雅医学院附属肿瘤医院胃十二指肠胰腺外科,长沙410013

出　　处：《中国现代手术学杂志》2013年第5期344-346,共3页Chinese Journal of Modern Operative Surgery

摘　　要：[摘要]目的总结本院胃癌根治术后吻合口漏或十二指肠残端漏的保守治疗经验，以期减少不必要的再次手术。方法对2010年11月～2012年11月期间我院胃肠肿瘤外科胃癌根治术后发生吻合口漏和十二指肠残端漏的11例病人行以保守治疗为主的综合治疗，回顾性分析其临床疗效。11例病人均予持续胃肠减压，双腔引流管持续引流加间断冲洗，B超引导穿刺，肠外营养逐步过渡到肠内营养，在肠外营养中使用了生长抑素，强化谷氨酰胺等新型营养制剂支持治疗，3例病人在漏愈合期加用了生长激素。结果在首次胃手术后28～40d自愈2例；术后41～103d愈合8例；其中1例因多次手术后严重感染合并MODS于首次术后63d死亡。结论保证腹腔引流管通畅、持续胃肠减压，特别是肠外结合肠内营养支持、生长抑素、谷氨酰胺等新型营养制剂，以及生长激素的应用等保守治疗措施是促进漏愈合的重要手段。应减少不必要的再次手术打击。Objective To summarize the experiences in conservative treatment for anastomotic leakage and duodenal stump leakage after radical resection of gastric carcinoma. Methods A total of 11 patients with anastomotic leakage （7 cases） and duodenal stump leakage （4 cases） after radical resection of gastric carcino- ma in our hospital from November 2010 to November 2012 were analyzed retrospectively. All the 11 cases were treated with continuous gastrointestinal decompression, abdominal cavity drainage, parenteral nutrition com- bined with enteral nutrition, including glutamine enrichment and somatostatin. 3 were supplemented recombi- nant human growth hormone. Results 2 cases healed 28 -40 days later. 8 cases healed in 41 to 103 days after operation. 1 case complicated with MODS and died 63 days after operation. Conclusions Treatment with continuous gastrointestinal decompression, abdominal cavity drainage, parenteral and enteral nutrition, and administration of glutamine, somatostatin and recombinant growth hormone are the keys to the healing of anasto- motic leakage and duodenal stump leakage, which can reduce the unnecessary operation rate.

关 键 词：胃肿瘤 肠瘘 胃瘘 引流术 肠道营养 胃肠外营养 

分 类 号：R735.2[医药卫生—肿瘤] R656.6[医药卫生—临床医学]