经腹胃癌全胃切除术后吻合口瘘的预防及处理  

Transabdominal total gastrectomy for gastric cancer prevention of postoperative anastomotic fi stula

作　　者：张崇广[1] 李少伟[1] 王文江[1] 

机构地区：[1]武警北京总队医院,北京100027

出　　处：《临床医药文献电子杂志》2016年第3期407-408,共2页Electronic Journal of Clinical Medical Literature

摘　　要：目的探讨全胃切除术后食管空肠吻合口瘘的预防及处理。方法选取2003年1月~2013年12月我院收治的胃癌全胃切除术患者96例作为研究对象,术前充分准备,采用经腹全胃切除术后p形空肠代胃,术中注意分离吻合技巧,配合使用吻合器,术后加强营养支持治疗。结果所有患者手术全部成功,无死亡,无吻合口瘘严重并发症发生。结论术前贫血、低蛋白血症合并糖尿病,术中食管残端分离过长,消化道重建方式选择不合理,吻合器使用操作不当是食管空肠吻合口瘘发生的主要原因。只要术前积极准备,术中细致操作,选择合理的消化道重建方式,正确使用吻合器,术后加强围手术期观察,积极营养支持改善营养状况,食管空肠吻合口瘘是完全可以预防的。Objective Study on jejunal anastomotic fi stula of esophagus after total gastrectomy occurrence causes and prevention. Methods Retrospective of 96 cases of total gastrectomy for gastric cancer patients, preoperative preparation,transabdominal p-shaped jejunal pouch interposition after total gastrectomy for gastric and note separation agreement in operation tips used in conjunction with Stapling and postoperative nutritional support therapy. Results This operation succeed,no deaths and no serious complications of anastomotic. Conclusion Preoperative anemia and low protein blood syndrome and diabetes mellitus,stump separated too long in the esophagus,digestive tract reconstruction method is unreasonable,stapler uses improper operation are the major risk factors for jejunal anastomotic fi stula of esophagus.As long as preoperative preparations and detailed actions in the operation,choose a reasonable reconstruction of digestive tract,the proper use of staplers,postoperative perioperative observation,positive nutritional support improved nutritional status of jejunal anastomotic fi stula of esophagus are completely preventable.

关 键 词：全胃切除术 消化道重建 吻合器 吻合口瘘 营养支持 

分 类 号：R735.2[医药卫生—肿瘤]