延长胃肠减压时间对食管癌术后吻合口瘘影响.doc

延长胃肠减压时间对食管癌术后吻合口瘘影响【摘要】目的：探讨延长胃肠减压的时间对食管癌术后吻合口瘘发生率及其处理的影响。方法：将216例食管癌患者随机分为实验组和对照组，实验组胃管留至术后10～12天，持续胃肠减压，同时经肠内营养管滴注瑞能；对照组于术后5～7天拔除胃管并进食流质饮食。两组患者均给予早期肠内营养支持。结果：实验组吻合口瘘发生率为4.6%，死亡率为0.9％；对照组吻合口瘘发生率为12%，死亡率为6.5％(P＜0.05)。结论：食管癌术后患者延长胃肠减压的时间可以减少吻合口瘘的发生率，降低吻合口瘘的死亡率。 【关键词】食管癌；胃肠减压；吻合口瘘 文章编号：1009-5519（2007）22-3340-02 中图分类号：R73 文献标识码：A Effect of prolongation gastrointestinal decompression on postoperative esophagogastric fistula in patients with esophageal carcinoma CHEN Yu-ping， LIU Jing-mei，LI Jin-lin （The Second Affiliated Hospital of North Sichuan Medical College（MianYang 404 hospital），SiChuan 621000，China） 【Abstract】Objective：To evaluate the effect and incidence of prolongation gastrointestinal decompression on postoperative esophagogastric stoma fistula in patients with esophageal carcinoma. Methods：216 cases of esophageal cancer were divided into two groups.The experimental group kept the gastrointestinal tube for 10～12 days after operation，kept on the gastrointestinal decompression and was given fresubin through gastrointestinal nutrition tube;while the control group was pulled out the gastrointestinal tube in 5~7 days after operation and given liquid diet. Two groups were used early enteral nutrition. Results：The incidence and mortality of esophagogastric stoma fistula in the experimental group was 4.6% and 0.9% respectively， the control group was 12% and 6.5% respectively(P＜0.05). Conclusion：Delaying to pull out the gastrointestinal tube in patients with esophageal carcinoma after operation could reduce the incidence and mortality of anastomotic fistula. 【Key words】Esophageal carcinoma；Gastrointestinal decompression；Anastomotic fistula 手术是治疗食管癌的首选方法，但是由于食管壁解剖结构的特殊性，使吻合口瘘成为食管癌术后最常发生的并发症，也是术后近期死亡的主要原因。食管癌术后胃肠减压是常规护理措施，本文就食管癌根治术后，将常规拔胃管和延迟拔胃管持续胃肠减压的两组患者进行比较，研究延长胃肠减压的时间对吻合口瘘的发生率及治疗效果的影响。 1 资料与方法 1.1 临床资料：2002年6月～2005年10月在我院行食管癌根治术的患者共216例，其中男134例，女82例，年龄39～73岁，平均年龄61岁。经术后病检确诊为食管癌，其中食管上段癌37例，食管中段癌102例，食管下段癌77例，均为根治性癌灶切除，胃代食管吻合201例，结肠代食管吻合1