食管贲门癌术后胸内吻合口瘘病例临床诊治研究.docVIP

食管贲门癌术后胸内吻合口瘘病例临床诊治研究【摘要】目的：探讨食管贲门癌术后胸内吻合口瘘的外科治疗。方法：2001年01月至2010年06月手术治疗胸下段食管贲门癌264例，均为胸内吻合，发生食管胃吻合口瘘8例，发生率3．3％。对该8例食管胃吻合口瘘患者均行开胸探查冲洗、重新置胸管充分引流、常规气管切开呼吸机辅助呼吸以及空肠造瘘肠内营养，并给予抗感染、静脉营养、持续胃肠减压治疗。结果：治愈7例，1例瘘口经胸腔与胸壁形成窦道，二次术后32天死于肺部霉菌感染。结论：对于早中期食管贲门癌术后胸内吻合口瘘，积极开胸冲洗并重新置管确保胸腔引流通畅，常规气管切开呼吸机辅助呼吸以及空肠造瘘肠内营养是有效的治疗方法。 【关键词】食管贲门癌；吻合口瘘；治疗 Cardiac thoracic esophageal anastomotic leakage within the clinical treatment of patients 【Abstract】Objective: To investigate cardiac thoracic esophageal anastomotic fistula in surgical treatment. Methods: from January 2001 to June 2010 thoracic surgical treatment of esophageal and cardiac carcinoma 264 cases are intrathoracic anastomosis, anastomotic leakage occurred esophagus in 8 cases, the incidence of 3.3%. The 8 patients with esophageal and gastric fistula patients underwent thoracotomy washing, re-set the full chest tube drainage, and conventional mechanical ventilation with tracheotomy and ostomy jejunal enteral nutrition, and to give antibiotics, parenteral nutrition, continuous stomach intestinal decompression treatment. Results: 7 patients were cured, 1 case of pleural and chest wall fistula formation by sinus, 32 days after the second died of pulmonary fungal infection. Conclusion: For the early and mid-cardiac thoracic esophageal anastomotic leakage within the active washing and re-thoracotomy chest tube drainage to ensure the smooth, conventional mechanical ventilation with tracheotomy and ostomy jejunal enteral nutrition is an effective treatment method. 【Key words】esophageal cardia; fistula; treatment 1对象和方法 1.1对象 2001年01月至2010年06月我科手术治疗胸下段食管贲门癌264例，均为胸内食管胃吻合，发生食管胃吻合口瘘8例，发生率为3.3％ ，男性7例，女性1例；年龄50～62岁，平均53.2岁；胸下段食管癌7例，贲门癌1例；病理类型为鳞癌7例，腺癌1例。均采用机械吻合器吻合加食管肌层与胃浆肌层间断缝合1周；发生瘘在术后3 d 内3例，4～10 d 5例。早期瘘从引流管中引出痰液、唾液及胃内消化液，中期瘘从引流管中引出食物残渣。患者主要表现有胸痛、发热、气短、呼吸困难，患侧呼吸音减弱或消失，中期瘘因部分已包裹，以局限性液气胸为主。 1.2方法 明确诊断后积极经原切口开胸探查，彻底清除坏死组织，逐步剥离清除纤维板，吸尽胸腔积液，温生理盐水多次冲洗胸腔；放置32号及24号两根闭式引流管到瘘口附近（4号线缝合壁层胸膜松扎固定引流管以确保引流到位），另外在第九肋间腋中线置32号胸引流管确保瘘出液能通畅地