食管癌术后吻合口瘘的诊断和治疗分析  

Treatment of anastomotic leakage following surgery for esophageal cancer

作　　者：胡海峰[1] 陶一勤[1] 李道航[1] 

机构地区：[1]安徽医科大学附属巢湖医院,238000

出　　处：《安徽医学》2015年第7期841-844,共4页Anhui Medical Journal

摘　　要：目的探讨食管癌术后并发吻合口瘘的诊断和治疗方法。方法回顾分析2005年1月至2014年5月行食管癌根治术750例患者临床资料,出现术后吻合口瘘28例,其中颈部吻合口瘘4例,左胸入路胸内吻合口瘘19例(弓上13例,弓下6例),Ivor Lewis术后吻合口瘘5例。所有吻合口瘘患者均采用禁食、胃肠减压、胸腔内引流、纵隔脓腔冲洗以及放置空肠营养管进行肠内营养和肠外营养等保守治疗。结果颈部吻合口瘘患者均治愈出院,3例胸腔内瘘患者死亡,其余胸腔内瘘患者均经积极治疗后痊愈出院,包括1例食管内置入支架患者。结论吻合口瘘是食管癌术后严重的并发症,早发现、早处理是食管癌术后的吻合口瘘治疗的关键。积极的保守治疗是处理食管癌术后吻合口瘘的有效措施。Objective To explore the methods of diagnosis and treatment of anastomotic leakage after surgical operation for esopha-geal cancer. Methods A total of 750 patients underwent esophageal carcinoma resection from January 2005 to May 2014. Postoperative anastomic leakage occurred in 28 cases, and of them the neck anastomotic fistula in 4 cases, the left intrathoracic anastomotic fistula in 19 cases:anastomosis above the aortic arch in 13 patients, below the arch in 6 cases, and 5 cases after Ivor Lewis surgery. All the patients were treated by fasting, gastrointestinal decompression, intrathoracic drainage, mediastinal abscess cavity irrigation and nasojejunal feeding by en-teral nutrition tube, parenteral nutrition, and so on. Results In 28 cases of anastomotic fistula after esophagectomy, all the patients with er-vical anastomotic fistula were cured, and 3 cases of death occurred in patients with cavitas thoracis fistula. The rest of the intrathoracic esoph-agogastric anastomotic fistulas were cured after active treatment, including 1 case of esophageal stent placement in the patient. Conclusion Anastomotic leakage is a serious complication after esophagectomy, and early detection and treatment is the key step for these patients. Con-servative treatment is effective treating method for anastomotic leakage after esophagectomy.

关 键 词：食管癌 吻合口瘘 并发症 食管碘油造影 肠内营养 

分 类 号：R735.1[医药卫生—肿瘤]