食管切除术后胸腔内吻合口漏的外科处理和防治  

Surgical treatment and prevention of anastomotic leakage in thoracic cavity after esophagectomy

作　　者：肖健[1] 杨潜[1] 乌立晖[1] 洪江[1] 孙光远[1] 王志农[1] 赵学维[1] 孙耀昌[1] 

机构地区：[1]第二军医大学长征医院胸心外科,上海200003

出　　处：《中国肿瘤外科杂志》2014年第5期273-276,共4页Chinese Journal of Surgical Oncology

摘　　要：目的探讨食管切除术后胸内吻合口漏的原因、治疗及预防。方法 1 812例食管切除术患者55例术后发生胸内吻合口漏,其中28例行非手术治疗,27例行手术治疗。结果非手术治疗的28例吻合口漏中,22例治愈,4例死亡,2例放弃治疗;手术治疗的27例中,26例治愈,死亡1例为吻合口漏修补术后再次发生吻合口漏,多脏器功能衰竭死亡。结论食管切除术后胸内吻合口漏病情危重,死亡率高,术中及围手术期采取有效预防措施可降低吻合口漏的发生率。治疗应首先采用非手术方法,如无好转应尽早手术治疗。治疗目的在于通畅引流,辅以肠内营养可取得较好治疗效果。Objective To evaluate the etiological factors,diagnosis,treatment and prevention of anastomotic leakage in thoracic cavity after esophagectomy. Methods There were 55 cases of anastomotic leakage among 1812 patients after taking the operation of esophagectomy. 28 patients were treated with non-operative treatment,27 patients were treated with operational treatment. Results 22 of 28 patients with non-operative treatment were cured,4 cases of death,2 cases were discharged voluntarily after giving up therapy;26 of 27 cases with operational treatment were cured. One case of postoperative recurrence of anastomotic leakage died of multiple organ failure. Conclusion The mortality rate of anastomotic leakage is higher in thoracic cavity after esophagectomy,and the active preventive measures therapy may reduce the incidence of anastomotic leakage. Treatment should be used non-surgical methods firstly. If there is no improvement,surgical treatment is supposed to be taken as soon as possible. The treatment aims to keep effective drainage,supplemented by enteral nutrition could get better therapeutic effect.

关 键 词：食管切除术 吻合口漏 病因分析 诊断 外科处理 

分 类 号：R735.1[医药卫生—肿瘤]