38例胃肠术后吻合口瘘的临床诊疗体会.docVIP

精品论文 参考文献 38例胃肠术后吻合口瘘的临床诊疗体会 袁军华1 王隽2 　　 ( 1新疆哈密地区中心医院外一科 839000;2新疆哈密地区中心医院急诊科 839400） 　　【摘要】目的：探讨研究胃肠术后吻合口瘘的临床治疗效果。方法：选择2010年6月到2014年3月在我院接受胃肠道切除术后并发吻合口瘘的38例患者，根据病情分为保守治疗组和手术治疗组，比较两组治疗效果。结果：保守治疗组例患者有12例患者吻合口愈合延迟，2周后治愈出院，4例患者2周后病情无变化，经过手术治疗后治愈出院，4例患者呼吸困难，衰竭死亡；手术治疗组15例患者2周后治愈出院，3例患者再次发生吻合口瘘，进行二次手术治疗，2例治愈，1例无效死亡。结论：根据手术后吻合口瘘患者的病情采用不同的治疗方法，能够有效地减少死亡率，缩短病程，减轻患者的负担。 　　【关键词】胃肠术 吻合口瘘 手术治疗 　　【???图分类号】R656.6 【文献标识码】A 【文章编号】1672-5085（2014）26-0078-02 　　Clinical experience of diagnosis and treatment of anastomotic fistula after gastrointestinal surgery in 38 cases 　　【Abstract】Objective: the clinical effect of the treatment of the anastomotic fistula after the operation of gastrointestinal. Methods: in 38 cases underwent anastomosis fistula after resection of gastrointestinal tract of patients in our hospital were divided into conservative treatment, according to the combination operation in treatment group, the treatment effects were compared between the two groups. Results: the conservative treatment group of 12 cases patients with anastomotic healing, 2 weeks after cured, 4 patients after 2 weeks without conditions change, after treatment cured after operation, 4 patients died of respiratory difficulties, failure in operation; 15 patients in treatment group were cured after 2 week, 3 patients were again anastomotic floor, were treated for two times operation, finally died. Conclusion: according to the fistula of anastomosis after operation in patients with the disease treated by different methods, can effectively reduce the mortality, shorten the course, reduce the burden of patients. 　　【Key words】gastrointestinal operation anastomotic fistula operation treatment 　　吻合口瘘是胃肠术后最严重的并发症，也是导致术后死亡的主要原因之一，死亡率达13%，给临床治疗带来很大麻烦[1]。胃肠术后口瘘的发病率较高，其发病因素复杂，至今未有明确的报告，术后一旦发生吻合口瘘，治疗困难，给医生带来很大压力。临床研究认为，胃肠术后吻合口瘘的发病因素主要有吻合口局部感染，术后用力过度、剧烈咳嗽，进食量过大和大口吞咽，导致胃部自身重力加大，使吻合口撕裂，形成吻合口瘘。临床症状为吻合不严密、组织切割坏死、局部供血不良、膨胀不全、组织愈合能力欠佳和局部缝线感染[2]。近年来，随着医疗