24例胃代食管术后吻合口、胸胃瘘治疗分析  

作　　者：李旭[1] 凌峰[1] 杨绍军[1] 王曦[1] 马建强[1] 赵芝婧 

机构地区：[1]昆明医科大学第二附属医院胸心血管外科,云南650101

出　　处：《当代医学》2014年第4期76-77,共2页Contemporary Medicine

摘　　要：目的：探讨胃代食管术后吻合口、胸胃瘘的原因和治疗措施。方法对2002-2012年进行378例胃代食管吻合术后出现的24例吻合口、胸胃瘘病例治疗情况进行分析和总结。结果本组存活16例，单纯颈部吻合口瘘存活11例。颈部吻合口瘘合并脓胸存活1例。胸内吻合口瘘存活2例。胸胃瘘2例均存活。其中随防11例，于术后1～3月均出现不同程度吻合口狭窄，返院多次行机械扩张后能正常进食。死亡8例，颈部吻合口瘘合并脓胸死亡4例。胸内吻合口瘘死亡3例，单纯颈部吻合口瘘死亡1例。结论术前合并其它疾病和术后合并其它并发症是发生吻合口瘘和吻合口难愈，同时也是致死的重要因素。颈部吻合口易出现瘘，但感染容易局限和控制，而感染侵入胸腔，后果亦极其严重。保守治疗是治疗吻合口和胸胃瘘最适用的方法。4.胸腔内感染越早出现包裹和局限，愈后越好。Objective To explore reasons and treatment of anastomotic leakage or intrathoracic gastric leakage after esophago-gastrostomy. Methods From 2002 to 2012, 378 patients underwent esophago-gastrostomy in our hospital, among which 24 cases suffered from anastomotic leakage or intrathoracic gastric leakage, we reviewed retrospectively these 24 cases. Results Among 24 patients, 16 patients survived, including 11 cases with single cervical anastomotic leakage, 1 case with cervical anastomotic leakage and empyema, 2 cases with intrathoracic anastomotic leakage, and 2 cases with intrathoracic gastric leakage. 11 surviving patients were followed, all of which suffered from anastomotic stenosis at different levels 1 to 3 months after esophago-gastrostomy, and could transorally take food normally after multiple mechanical dilatation. Among 24 cases, 8 patients died, including 4 cases with cervical anastomotic leakage and empyema, 3 cases with intrathoracic anastomotic leakage, and 1 case with single cervical anastomotic leakage. Conclusion Patients combined with other diseases before esoghago-gastrostomy or suffered from complications postoperatively predispose to anastomotic leakage or unsatisfactory anastomotic healing;2, Cervical anastomosis predispose to leakage, but infection resulted from cervical anastomotic leakage inclines to localization and easy control, if the infection invaded into thoracic cavity, it usually caused serious conditions;3, it is the most appropriate method to take conservative managements to treat anastomotic leakage or intrathoracic gastric leakage;4, the more early localization of intrathoracic infection happened, the better prognosis got.

关 键 词：胃代食管吻合术后 吻合口 胸胃瘘 

分 类 号：R735.1[医药卫生—肿瘤]