食管癌切除术后颈部吻合口瘘临床分析.docVIP

食管癌切除术后颈部吻合口瘘临床分析 　　【摘要】 目的：探讨食管贲门癌切除术后吻合口瘘的预防手段和有效的治疗措施。方法：回顾性分析本院收治、行食管癌切除和颈部食管胃吻合术的37例食管癌患者的临床资料。结果：全部病例均手术成功，其中7例发生颈部吻合口瘘，对患者进行密切临床观察，胃肠减压、胸腔闭式引流，肠内外营养支持治疗及基础护理等措施进行保守治疗，6例治愈，1例死亡。结论：食管癌切除术后吻合口瘘的发病率较高，需加强观察患者症状和体征，密切护理、积极预防、早期发现和对症治疗是吻合口瘘治愈的关键。 　　【关键词】 食管癌切除； 颈部吻合口瘘； 预防； 治疗 　　Clinical Analysis of Cervical Anastomotic Fistula after Esophageal Cancer Resection/LI Qi， LUO Xiao-li.//Medical Innovation of China，2013，10（15）：119-120 　　【Abstract】 Objective： To explore the prevention means and effective treatment measures for the postoperative cervical anastomotic fistula of esophageal cancer. Method： 37 cases of esophageal cancer patients treated with resection or neck esophagus stomach anastomosis were retrospectively analyzed， also and their clinical data and treatment experiences. Result： All the operations were successful in which 7 cases of cervical anastomotic stomach fistula were found. All the cases of cervical anastomotic stomach fistula were treated with conservative therapy including close observation， and gastrointestinal decompression， and thoracic closed drainage， and nutrition support， and so on. 6 cases were cured， while 1 case died. Conclusion： There is a high incidence of cervical anastomotic stomach fistula after esophageal cancer resection which should be taken seriously and nursed closely. The early detection and symptomatic treatment is the key of healing. 　　【Key words】 Esophageal cancer resection； Cervical anastomotic stomach fistula； Prevention； Therapy 　　First-author’s address： The People’s Hospital of Taikang， Taikang 461400， China 　　doi：10.3969/j.issn.1674-4985.2013.15.063 　　吻合口瘘是食管癌、贲门癌切除术后的严重并发症之一，发病率和致死率都较高[1]。据文献报道，吻合口瘘是食管癌手术最主要的死因[2]，也是目前临床食管癌手术治疗的瓶颈之一。本院回顾分析37例行食管癌切除和颈部食管胃吻???术的食管癌患者资料，以期为颈部吻合口瘘的预防和治疗提供临床依据，现报告如下。 　　1 资料与方法 　　1.1 一般资料 研究对象为本院收治的37例食管癌患者，其中男19例，女18例，年龄41～73岁，平均（57.1±11.4）岁。病理部位：食管上段癌11例，食管中段癌19例，食管下段癌7例。病理分型：鳞癌29例，腺癌6例，腺鳞癌2例。 　　1.2 手术方法 手术入路均采用左胸前外侧加左颈部切口入路，进行食管癌切除、经食管床食管胃颈部吻合术。 　　1.3 颈部吻合口瘘治疗方法 一旦确诊为颈部吻合口瘘，迅