食管癌、贲门癌术后胸内吻合口瘘治疗体会

    Treatment of intrathoracic anastomotic leakage following surgery for esophageal cancer and cardia cancer

    • 摘要: 目的:探讨食管癌、贲门癌术后并发胸内吻合口瘘的治疗方法。方法:21例行双套管充分引流、控制脓胸、防治呼吸衰竭、营养支持等保守治疗,4例行二次开胸手术清理脓腔及置管引流,1例二次开胸手术切除原吻合口后于颈部重新吻合;7例放置带膜钛-镍记忆合金食管支架,其中3例为二次开胸清理置管引流手术同时置入带膜食管支架。结果:治愈21例,术后住院时间26~73天,其中3例二次开胸清理置管引流结合食管带膜支架置入患者于术后26~28天痊愈出院。病死5例,死因均为感染未控制导致呼吸衰竭、中毒性休克。结论:合理选择和改进治疗方法能提高胸内吻合口瘘的疗效,积极二次开胸清理置管引流结合食管带膜支架置入的方法值得进一步探讨。

       

      Abstract: Objective:To explore the treatment of anastomotic leakage after surgical operation for sophageal cancer and cardia cancer.Methods:Twenty-one of them received double-tube full drainage,empyema control,treatment for respiratory failure,nutritional support and other conservative therapies;4 of them underwent a second thoracotomy and catheter drainage for abscess cleaning,and 1 of them received a second thoracotomy and re-anastomosis in the neck after resection of the original anastomosis;7 cases were placed titanium-nickel-memory alloy covered esophageal stent,3 of whom had undergone a second thoracotomy and catheter drainage.Results:Twenty-one cases were cured;the postoperative hospital stay was 26 to 73 days,including 3 patients who had received a second thoracotomy,catheter drainage and esophageal stent implantation.Five died.The causes of death were respiratory failure and toxic shock due to uncontrolled infection.Conclusions:Proper selection and improved procedures can improve the clinical efficacy on intrathoracic anastomotic leakage.The procedure of secondary thoracotomy tube drainage and esophageal stent placement is worth investigating.

       

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