胸内食管胃吻合口瘘16例诊治分析.DOCVIP

临床医学论文-胸内食管胃吻合口瘘16例诊治分析 ???????????????? 作者：姚维深　郭慧梅　李开河 【关键词】? 食管 　　摘要:目的:探讨胸内胃食管吻合口瘘的诊断和治疗。方法：我院自1994年1月至2003年12月对353例贲门癌、 食管癌行切除左胸内吻合术，术后并发吻合口瘘16例，根据患者不同临床表现、 胸片、 B超及胸部CT结果选择并改进治疗方法，12例选择手术治疗，4例保守治疗。对治疗结果进行回顾性分析。结果：1例高龄患者再手术后并发心衰死亡，死亡率6.25%(1/16),其余病例均治愈。2例术后再发瘘，经保守治疗痊愈,发生率16.67%(2/12)。结论：早期诊断、 恰当选择和改进治疗方法能提高胸内吻合口瘘的疗效。B超和CT结合使用有助于诊断和指导治疗。 　　关键词: 食管癌；贲门癌；手术；吻合口瘘 　　Diagnosis and Treatment of 16 Gastroesophageal Anastomotic Fistula 　　　Abstract： Objective:To investigate the diagnosis and treatment of gastroesophageal anastomotic fistula (GAF) in left chest.Method: Resection and gastroesophagostomy was performed in 353 patients with esophageal and cardic cancer from January 1994 to December 2003. GAF occurred postoperatively in 16 patients.The different treatment for 16 patients was choosed and improved according to individual clinic findings and results of chest X-ray,CT,B-ultrasound. Reoperation was performed in 12 patients and conservative treatment in 4.The outcome of treatment was retrospectively reviewed.Result:1 aged patient was dead post-reoperatively with a mortality rate of 6.25%(1/16).The cause of death was heart failure.The others were cured including 2 patient with re-fistula after reoperation through conservative treatment.The rate of re-fistula was 16.67%(2/12).Conclusion:It can improve the outcome for the patients with GAF to diagnose early,choose and improve treatment properly.A combined use of B-ultrasound and CT is beneficial to diagnosis and guide treatment. 　　Key words：Esophagus cancer；Cardic cancer；Operation；Anastomotic fistula　　胸内吻合口瘘是食管癌、贲门癌手术的第一并发症,也是第一死因［1］。发生率国内外多数报道在3～5%之间，死亡率曾高达50%［2］。虽近年来已明显下降，但降低吻合口瘘的发生率和死亡率仍是胸外科医生努力探讨的问题。自1994年4月至2003年12月,我院共行食管癌、 贲门癌切除,胃食管左胸内吻合术353例,术后吻合口瘘16例,发生率4.53%,其中12例接受再手术治疗,1例死亡,其余治愈。4例保守治疗均治愈。现结合文献分析报告如下。 　　1 资料与方法 　　1．1 一般资料：本组16例，男13例，女3例。年龄45～75岁，中位数年龄58岁。胸中段食管癌6例，胸下段7例，贲门癌3例。术后病理诊断：鳞癌13例、腺癌2例、小细胞癌1例。切缘有癌细胞侵润2例。术前所有患者营养均良好。手术均采用左胸入路，主动脉弓下吻合9例，弓上吻合7例。吻合口瘘均发生在术后2～10d，经B超定位、口服美蓝并胸穿等检查后确诊。 　　1.2 治疗方法：本组中4例患者吻合口瘘