食管贲门癌术后胸内吻合口及胸胃瘘的临床处理.DOCVIP

临床医学论文-食管贲门癌术后胸内吻合口及胸胃瘘的临床处理 【关键词】? 食管癌 　　［摘 要］ 目的? 探讨食管癌、贲门癌切除术后胸内吻合口及胸胃瘘的合理治疗方法。 方法? 回顾1369例食管癌、贲门癌切除术后病人的临床资料，总结胸内吻合口瘘及胸胃瘘的正确处理方法。 结果? 全组共发生胸内吻合口及胸胃瘘25例，其中吻合口瘘19例，胸胃瘘6例，总发生率为2.0%，死亡率为28.0%。行保守治疗19例，死亡5例，死亡率为26.3%;行二次开胸6例，死亡2例，死亡率为33.3%。 结论? 胸内吻合口瘘及胸胃瘘是食管重建术后严重的并发症，综合应用静脉高价营养和胃肠内营养等治疗手段是处理胸内瘘的有效的保守治疗方法。?????? 　　［关键词］ 食管癌;贲门癌;吻合口瘘;胸胃瘘;临床处理??????????? 　　Clinical procedures of anastomotic and thoracic gastric leakage after resection of esophageal and gas-tric cardial carcinoma??????????? 　　Abstract:Objective To explore the rational therapy of anastomotic and thoracic gastric fistula after the resection of esophageal carcinoma and cardial carcinoma.Methods A retrospecive analysis was compiled of1369patients undergoing the resection of esophageal carcinoma and cardial carcinoma and reconstruction.Results The intrathoracic anastomotic fistula and thoracic gastric fistula occurred in25patients with an overall inci-dence of2.0%and an overall mortality of28.0%.Among them intrathoracic anastomotic fistula was in19patients，thoracic gastric fistula in6.Five patients died and14were cured in the conservative treatment group with a mortality of26.3%.Two patients died in the reanastomosis treatment group with a mortality of33.3%.Conclusion Anastomotic and thoracic gastric fistula is considered to be one of the most serious complications af-ter esophageal reconstruction.Combined application of total parenteral nutrition and enteral nutrition is the suitable non-traumatic therapy.????? 　　Keywords:esophageal carcinoma;cardial carcinoma;anastomotic fistula;thoracic gastric fistula;clinical procedure?????? 　　胸内吻合口瘘和胸胃瘘是食管癌、贲门癌术后最主要的死亡原因之一。据报道胸内吻合口瘘的死亡率为50%［1］ ，胸胃瘘与之相仿。目前随着吻合技术的进步，吻合口瘘和胸胃瘘的发病率已有明显的下降。我们对1369例食管癌贲门癌切除、食管重建术后病人发生胸内瘘的情况及治疗经过进行回顾性分析，现总结报告如下。 　　1 资料与方法 　　1.1 临床资料???? 　　本组中男性961例，女性408例，男女之比为2.36∶1，年龄28～86岁，平均55.4岁。食管癌1012例，贲门癌357例。全组颈部吻合117例，胸内吻合1252例，其中双侧胸顶吻合157例，主动脉弓上吻合572例，主动脉弓下吻合523例。采用“间断全层+浆肌层包埋”手工吻合772例，采用美国强生公司C（S）DH25mm圆形吻合器及国产常州WGW26mm弯管吻合器行胸内机械吻合59