Stapler技术治疗颈段气管食管瘘的临床疗效分析  

Clinical efficacy of stapler technique for repair of cervical tracheoesophageal fistula

作　　者：张金周 杨建宝[1] 李斌[1] 张建华[1] 蒋鹏[1] 宋铁牛[1] 魏小平[1] 朱多杰 孟于琪[1] 郭权威[1] 

机构地区：[1]兰州大学第二医院胸外科兰州大学第二临床医学院,兰州730030 [2]甘肃省人民医院重症医学科,兰州730000

出　　处：《中国胸心血管外科临床杂志》2018年第2期153-158,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省自然科学基金项目(1308RJZA123)

摘　　要：目的探讨Stapler技术在治疗颈段气管食管瘘中的临床疗效。方法回顾性分析2014年10月至2016年10月兰州大学第二医院胸外科8例气管食管瘘患者的临床资料,其中男5例、女3例,平均年龄23~67(46.4±13.9)岁。4例患者气管食管瘘由气管插管导致,2例由食管异物导致,1例由气管支架导致,1例由食管憩室导致。全部患者行Stapler技术闭合瘘口,术后通过Karnofsky功能状态(KPS)评分、影像学情况、患者满意度调查和患者进食呛咳症状改善情况来评价手术效果。结果手术过程顺利,手术时间为(117.5±6.6)min,术中出血量为(60.0±7.0)ml。术后患者无切口出血和感染、声音嘶哑、呼吸困难、饮水呛咳、瘘口复发及气管食管狭窄等并发症,无围术期死亡病例,1周后胸部X线片示肺部感染症状消失,仅1例患者术后1年出现食管狭窄。术后2周KPS评分为(90.0±7.0)分,较术前明显改善(P<0.01),术后肺部感染面积较术前减少(P<0.05),气管食管瘘消失,患者总体满意率为90%,进食呛咳症状改善情况评价为优。结论 Stapler技术是治疗颈段气管食管瘘的有效术式,具有安全、简便、手术时间短、术后并发症少、疗效可靠等优点。Objective To evaluate the clinical efficacy of fistula repair by stapler technique in patients with cervical tracheoesophageal fistula. Methods Retrospective analysis of 8 patients with cervical tracheoesophageal fistula who accepted operative treatment in the Department of Thoracic Surgery, Lanzhou University Second Hospital from October 2014 to October 2016 was conducted. There were 5 males and 3 females at a mean age of 46.4±13.9 years ranging from 23 to 67 years. The fistula was induced by tracheal intubation in 4 patients, by esophageal foreign bodies in 2, by tracheal stent in 1 and by esophageal diverticulum in 1. The fistula was closed by stapler technique. The surgical effects were evaluated through Karnofsky performance score （KPS）, image assessment, patient satisfaction score and assessment of improvement in feeding-induced bucking. Results The operations were performed successfully with time of 1t7.5±6.6 min and intraoperative blood loss of 60.0±7.0 ml. After the operations, the patients did not suffer incision bleeding and infection, hoarseness, dyspnea, drinking-induced bucking, fistula relapse, tracheoesophageal stenosis or any other complications, and no death occurred during the perioperative period. The chest X-ray test was performed 1 week later showed that the pulmonary infection disappeared, and only I patient suffered from esophageal stenosis 1 year later. The postoperative KPS score was 90.0±7.0 points, which significantly improved in contrast to preoperation （P〈0.01）. Postoperative pulmonary infection area reduced significantly （P〈0.05）, tracheoesophageal fistula disappeared,postoperative patients satisfaction rate was 90%, and assessment of feeding-induced bucking was exceUent. Condusion Using stapler technique to repair cervical tracheoesophageal fistula is safe, easy and useful, with less operation time and postoperative complications.

关 键 词：颈段气管食管瘘 Stapler技术 疗效分析 

分 类 号：R653[医药卫生—外科学]