预防食管癌及贲门癌手术吻合口并发症的临床研究.DOCVIP

临床医学论文-预防食管癌及贲门癌手术吻合口并发症的临床研究 ????????????? 作者：谷兰海，杜庆霞，高晓旭 【关键词】? ,食管肿瘤；贲门肿瘤；手术；OB吻合胶；肠内营养；并发症 　　［摘要］ 目的：采取综合措施预防食管癌及贲门癌手术吻合口并发症的发生。方法：我院自2001年3月至2006年4月连续行食管癌及贲门癌切除手术326例，术前充分准备，术中保持胃及食管良好的血运，细致的吻合，并行吻合口包埋，术中应用OB吻合胶，术后应用肠内营养。结果：全组患者无吻合口瘘。胃排空障碍1例，经十二指肠营养管进食，对症处理，于术后第26天恢复经口进食。无中重度吻合口狭窄及膈疝发生。结论：手术操作熟练、认真、细致是减少吻合口并发症的关键因素，术中应用OB吻合胶及术后肠内营养支持对降低吻合口并发症的发生起到一定作用。 　　［关键词］ 食管肿瘤；贲门肿瘤；手术；OB吻合胶；肠内营养；并发症 　　Clinical Study in Preventing Anastomotic Complications in Operation of Esophageal or Gastric Cancer 　　　　Abstract : Objective Take synthetical measures to decrease anastomoticcomplications in operation of esophageal or gastric cancer. Methods From 2001,3 to 2006 ,4, 326 consecutive patients under wentesophagectomy or gastrotomy. Through full preparation before operation,keeping good blood supply of stomach and esophagus during operation, careful anastomosis,wrapping up anastomotic rim, using medical anastomotic clue, apply enteral nutrition after operation. Results All patients have not occurredanastomotic leak. 1 case of them occurred thoracic stomach empting disturbance, supplying nutrition through duodenum nutrition tube, treating against symptims, resuming in take foods through mouth 26 days after operation.All patients have not occurred severe stricture formation and diaphragm hernia. Conclution The operation should be careful and skillful to decease anastomotic complications, usingmedical anastomotic clue and applying enteral nutrition after operation take important roles in deceasing anastomotic complications. 　　Key words: Esophageal neoplasm; Cardial neoplasm; Operation ; Medical anastomotic clue; Enteral nutrition; Complication 　　自2001年3月至2006年4月笔者连续行食管癌及贲门癌切除手术326例，无吻合口瘘及中重度吻合口狭窄并发症发生，胃排空障碍的发生率明显降低，取得了较好效果，现总结如下。 　　1　资料与方法 　　1.1　一般资料　本组共326例，男 206例，女120 例。年龄43岁～79岁，平均年龄63.3岁，其中胸上段食管癌12例，胸中段食管癌101例，胸下段食管癌105例，贲门癌108例。术前营养状况评价：正常298例，轻度脱水伴营养不良20例，中度脱水伴营养不良8例。合并肝功能异常10例，糖尿病8例，心肺疾病12例。左胸弓上食管胃吻合128例，左胸食管胃弓下吻合123例，右胸顶食管胃吻合53例，颈部食管胃吻合21例。术前行常规开胸准备，口服庆大霉素8万　U，3次/d，正确指导患者进食，