食管癌、贲门癌术后吻合口瘘的预防及处理.pdfVIP

实用预防医学 2007年12月 第 14卷 第6期 Practical Preventive Medicine．Dec．2007，Vol 14．No．6 1869 文章编号：1006—311o(2007)o6—1869—02 食管癌、贲门癌术后吻合口瘘的预防及处理 肖 君 ，张 翼 ，谢 虹。 摘要： 目的 探讨食管癌、贲门癌术后吻合口瘘的预防及处理。 方法 对我院1998年4 一2007年1月共收 治的315例食管癌、贲门癌手术病人，术后发生7例吻合El瘘的原因及术中、术后的处理加以分析。 结果 1例颈部吻 合口瘘病人，因吻合151瘘通入胸腔，感染加重，衰竭死亡。1例因肺部感染，呼吸衰竭死亡。5例病人治愈出院。 结论 针对食管癌、贲门癌术后吻合El瘘可能出现的原因，术中、术后采取正确的措施加以预防和处理，能降低瘘的发生率和病 死率。 关键词： 食管癌；贲门癌；吻合口瘘；预防；治疗 中图分类号：R735．1 文献标识码：A Prevention and Management of Post—esophagogastrectomy Anastomotic I eakage for Oesophageal and Gastric Cardia Cancer X／AO Jun，ZHANG Yi，XIE Hong(Department of Thoracic and Cardiovascular Surgery，the First People’S Hospital，Yu· eyang 414000，Hunan) Abstract： 0bjective To investigate the management and prevention of anastomotic leakage of post—esopha— gogastrectomy for esophageal and gastric cardia carcinomas． Methods A retrospective analysis about factors and treat— ments was conducted on 7 anastomosis leakage patients who were performed operation for oesophageal and gastric cardia carcinoma frOm April，1 998 through January，2007． Results One cervical esophagogastrostomy leakage patient died of severe thorax infection，1 patient died of severe pulmonary infection，and the remaining 5 patients were cured． Conclusions To reduce the mortality and morbidity of post esophagogastrectomy anastomotic leakage of esophageal and gastric cardia carcinoma，the appropriate prevention and treatment measures based on the reason of the anastomotic leakage must be per— formed during the intraOperative and pOstOperatiVe care． Key words： Esophageal cancer；Cardiac cancer；Anastomotic leakage；Prevention；Treatment 吻合rI瘘是食管癌、贲门癌术后严重的并发症，其死亡率 定位，口服美兰并胸穿检查证实。 达50％，所以预防吻合口瘘发生，及其处理是非常重要，亦是很 1．2 治疗方法 2例颈部吻合口瘘，发生在术后4 d，7 d，切口 棘手的 我们收集了我院199