胃癌术后消化道瘘81例临床观察  

Clinical Investigation on 81 Cases of Gastrointestinal Leakage After Surgery for Gastric Cancer

作　　者：贾楠[1] 李勇[1] 魏明[1] 范立侨[1] 赵群[1] 张志栋[1] 王冬[1] 

机构地区：[1]河北医科大学第四医院,河北石家庄050011

出　　处：《肿瘤学杂志》2015年第5期373-377,共5页Journal of Chinese Oncology

基　　金：国家自然科学基金(81072033;81372580);河北省自然科学基金(C2010000619);河北省普通高校强势特色学科资助项目(冀教高[2005]52);河北省科技支撑项目(14277779D);河北省卫生厅重大医学科研课题(zd2013040)

摘　　要：[目的]研究胃癌术后发生消化道瘘的影响因素及预防和诊疗措施。[方法]收集接受住院手术切除的胃癌患者5702例,对其中发生消化道瘘的81例患者的各项数据资料进行分析。[结果]消化道瘘发生率为1.42%。胃癌合并糖尿病患者消化道瘘发生率为6.04%;患者术前贫血者消化道瘘发生率为2.11%;患者术前白蛋白低于30g/L者消化道瘘发生率为4.13%;胃癌合并联合脏器切除患者消化道瘘发生率为5.31%。62例消化道瘘的患者经保守治疗后53例愈合,9例死亡;19例经手术治疗者全部愈合。[结论]胃癌术后消化道瘘的发生与术前贫血和低蛋白血症有关,术前应纠正贫血以及营养不良等因素,并同时对糖尿病进行积极治疗。术后保持引流的通畅,合理应用肠外及肠内营养制剂和抗生素可促进消化道瘘的愈合。[Purpose]To investigate the factors influencing the occurrence of gastrointestinal leakage after gastric cancer operation and its preventioh,diagnosis and treatment. [Methods ] Data of 5702 cases with gastric cancer undergoing gastrectomy were collected. And of them,81 cases with gastrointestinal leakage were analyzed. [Results] The incidence rate of gastrointesti- nal leakage was 1.42% in gastric cancer patients, and it was 6.04% in gastric cancer with dia- betes patients; 2.11%, in gastric cancer with anemia patients ; 4.13%, in gastric cancer with hy- poproteinemia patients;5.31% ,in gastric cancer with multivisceral excisions. Fifty-three case of gastrointestinal leakage were healed and 9 cases died after conservative treatment. All of 19 case by operation treatment of gastrointestinal leakage were healed. [Conclusion] Gastrointesti- nal leakage is related to preoperative anemia and hypoproteinemia. Anemia, malnutrition should be treated before surgery for gastric cancer patients, and diabetes should be treated actively to reduce the risk of gastrointestinal leakage. Keeping the drainage unobstructed ,reasonable ap- plication of enteral or parenteral nutrition and antibiotics could promote the healing of gas- trointestinal fistula.

关 键 词：胃肿瘤 围手术期 消化道瘘 治疗 

分 类 号：R735.2[医药卫生—肿瘤]