食管癌术后吻合口瘘的发生原因与治疗

doi:10.3969/j.issn.10056483.2019.02.021

摘要/Abstract

摘要： 目的:探讨食管癌术后吻合口瘘的发生原因及治疗方法。方法:选取食管癌、贲门癌病人3815例，术后确诊吻合口瘘320例，分析吻合口瘘发生的原因及相关因素。按照吻合口瘘保守治疗方法不同分成两组：内引流组（内镜直视下经瘘口放置引流管）38例，外引流组（胸腔闭式引流）282例。比较两组拔管时间、住院时间及围手术期死亡率。结果:食管癌术后吻合口瘘发生率为8.39%，死亡率为1.88%，吻合口瘘与年龄、吻合口部位、术后前3天平均胃液引流量具有相关性（P＜0.05）。内引流组、外引流组拔管时间分别为（23.50±18.64）d，（30.60±14.08）d；住院时间分别为（32.45±20.60）d，（54.12±25.08）d，两组比较差异均有统计学意义（P＜0.05）；死亡率分别为0和2.13%，两组比较差异无统计学差异（P＞0.05）。结论:病人年龄＜60岁，主动脉弓下吻合，前3天平均胃液引流量多者术后吻合口瘘发生率低。内镜直视下经瘘口放置内引流，能快速改善病人症状，缩短拔管及住院时间，临床值得推广。

关键词: 食管癌, 吻合口瘘, 治疗

Abstract: Objective:To investigate the causes and treatment of anastomotic leakage after resection of esophageal carcinoma.Methods:3815 cases of esophageal and cardiac cancer were treated by operation.320 cases of anastomotic leakage were diagnosed after operation，and the causes and related factors of anastomotic leakage were analyzed.According to the conservative treatment of anastomotic leakage，they were divided into 2 groups：the internal drainage group（endoscopic direct drainage under the drainage tube），and the external drainage group（closed thoracic drainage）were 38，282 cases，respectively.The time of extubation，the time of hospitalization and the mortality in the perioperative period were compared between the two groups.Results:The incidence of anastomotic leakage after esophageal cancer resection was 8.39%，and the mortality was 1.88%.Anastomotic leakage was related to age，location of anastomotic position，average gastric flow of 3 days after operation（P＜0.05）.The extubation time[（23.50±18.64）d vs.（30.60±14.08）d] and hospitalization time [（32.45±20.60）d vs.（54.12±25.08）d] of the internal drainage group were significantly shorter than those of the external drainage group （P＜ 0.05），and there was no significant difference in the mortality rate （0 vs.2.13%）（P＞0.05）.Conclusion:The incidence of anastomotic leakage in patients with younger than 60 years，Inferior anastomosis of the aortic arch and more average gastric flow of 3 days after operation was low.The placement of internal drainage through the fistula in endoscopic vision can rapidly improve the symptoms，shorten the extubation and hospitalization time，and is worthy of popularization.

Key words: esophageal cancer, anastomotic leakage, treatment

汪林宝, 赵坚, 李小飞. 食管癌术后吻合口瘘的发生原因与治疗[J]. 临床外科杂志, 2019, 27(2): 152-154.

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