食管癌Ivor-Lewis术后吻合口-气管瘘的诊治  

Diagnosis and Therapeutic Approach of Anastomotic Leakageinduced Tracheobronchial Fistula after Ivor-Lewis Esophagectomy

作　　者：肖平[1] 庄翔[1] 李强[1] 王祥[1] 杨晓军[1] 谢天鹏[1] 胡彬[1] 戴维[1] 

机构地区：[1]四川省肿瘤医院胸外科,成都610041

出　　处：《肿瘤预防与治疗》2016年第5期271-275,共5页Journal of Cancer Control And Treatment

摘　　要：目的：探讨食管癌Ivor-lewis手术后吻合口-气管瘘的诊治。方法：回顾性分析22例食管癌Ivor-lewis手术后发生吻合口-气管瘘的临床资料。结果：从2006年6月-2015年5月,我科共行食管癌Ivor-lewis手术3 821例,术后发生吻合口-气管瘘22例（0.57%,22/3 821）。吻合口-气管瘘22例患者均采用保守治疗。8例直接行内镜下食管覆膜支架治疗,2例死亡,6例治愈;8例经呼吸机或纵膈引流后再行内镜下食管覆膜支架治疗,均痊愈;6例仅行引流、抗感染及营养支持治疗,2例死亡,4例治愈。结论：吻合口-气管瘘是食管癌Ivor-lewis手术后少见但严重危及生命的并发症。需根据病情的不同采用合适的治疗方式。Objective： To investigate the diagnosis and therapeutic approach of anastomotic leakage-induced traeheobronchial fistula after Ivor-Lewis esophagectomy. Methods： Clinical data of twenty-two cases of anastomotic leakageinduced tracheobronchial fistula after Ivor-Lewis esophagectomy in our department were retrospectively analyzed. Results： From June 2006 to May 2015, 3 821 patients with esophageal carcinoma underwent Ivor-Lewis esophagectomy in our department. Twenty-two （0. 57% , 22/3 821 ） patients developed anastomotic leakage-induced tracheobronehial fistula and all received conservative treatment. Eight patients underwent endoscopic insertion of covered stent, among them, 6 cased recovered, 2 patients died of multiple organ failure. Eight eases accepted endoscopic insertion of covered stent through ventilator or after the mediastinal drainage, and all were cured. In other six patients, 4 were cured by decompression, anti-infective treatment and nutritional support, 2 died of lung infection and respiratory failure. Conclusion： Anastomotic leakage-in- duced tracheobronchial fistula is a rare but life-threatening complication after esophagectomy for esophageal cancer patients. When an anastomotic leakage-induced tracheobronchial fistula is diagnosed, appropriate treatment should be applied according to different conditions.

关 键 词：食管癌 食管切除术 吻合口-支气管瘘 

分 类 号：R735.1[医药卫生—肿瘤] R730.6[医药卫生—临床医学]