切割吻合器直接关闭并隔离治疗良性获得性气管食管瘘的临床研究

发布时间：2018-03-13 16:25

本文选题：气管食管瘘　切入点：切割吻合器　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨切割吻合器在良性获得性气管食管瘘手术治疗中的近远期临床效果。方法回顾分析2005年4月至2016年11月郑州大学人民医院胸外科应用气管食管瘘切开分别修补术治疗的良性获得性气管食管瘘患者,排除合并气管或(和)食管狭窄者,排除合并气管或(和)食管损伤需重建者,共计入组41例。根据术中闭合瘘口时是否使用一次性切割吻合器分组,分为常规组与切割吻合器组。运用统计学方法对比分析2组患者手术时间、术中出血量、拔除引流管时间、术后住院时间,统计2组患者术后缝合口破裂、再瘘、感染、狭窄及死亡的发生率。结果全组41例均成功实施气管食管瘘切开分别修补术。常规组共计19例:术后出现瘘口缝合处破裂4例(21.05%),感染3例(15.79%),再瘘1例(5.26%),死亡1例(5.26%)。切割吻合器组共计22例:术后出现瘘口缝合处破裂1例(4.55%)。相比,切割吻合器组患者术后并发症发生率明显低于常规组。常规组患者平均手术时间为(278.9±39.5)min,术中出血量为(198.4±102.4)ml,拔除引流管时间为(12.8±6.6)d,术后住院时间为(19.5±4.9)d。切割缝合器组患者平均手术时间为(228.2±37.9)min,术中出血量为(118.2±74.6)ml,拔除引流管时间为(9.5±2.9)d,术后住院时间为(17.0±2.9)d。经统计学分析,2组患者手术时间和术中出血量有明显统计学差异,拔除引流管时间和术后住院时间未见明显统计学差异。结论应用切割吻合器直接关闭并隔离治疗良性获得性气管食管瘘的手术方式相较于常规气管食管瘘切开分别修补术优势明显,闭合瘘口更加确切牢靠,更有效的较少术中污染,同时可以简化手术流程,明显缩短手术时间,减少术中出血,有效避免术中副损伤及术后近远期的并发症发生,效果肯定,值得推广。
[Abstract]:Objective to investigate the clinical effect of cutting stapler in the treatment of benign tracheoesophageal fistula. Methods from April 2005 to November 2016, retrospective analysis of tracheoesophageal fistula was performed in the Department of Thoracic surgery, Zhengzhou University people's Hospital. Do not repair benign acquired tracheoesophageal fistula, The patients with trachea or / and esophageal stricture were excluded, and those complicated with trachea or / and esophageal injury needed to be reconstructed. A total of 41 cases were divided into groups according to whether or not one-off cutting stapler was used to close the fistula during operation. The patients in the two groups were divided into two groups: the operation time, the amount of blood lost during operation, the time of pulling out the drainage tube, the time of hospitalization after operation, the rupture of the suture, the recurrence of fistula and the infection of the two groups. Results the tracheoesophageal fistula was repaired successfully in 41 cases. 19 cases in the routine group: 4 cases had rupture of fistula suture after operation, 3 cases had infection, 1 case had fistula 5.26%, and 1 case died. There were 22 cases in the group of cutting stapler: 1 case had rupture of fistula suture after operation, and 4.55 cases had ruptured after operation. The average operative time, blood loss, drainage tube and hospital stay were 278.9 卤39.5 min, 198.4 卤102.4 ml, 12.8 卤6.6 d, 19.5 卤4.9 d, respectively. The average operative time was 228.2 卤37.9 min, the amount of intraoperative bleeding was 118.2 卤74.6 ml, the time of removing drainage tube was 9.5 卤2.9 days, and the postoperative hospitalization time was 17.0 卤2.9 days. There was no significant difference between the time of extubation and the length of hospital stay after operation. Conclusion the operative method of treating benign acquired tracheoesophageal fistula by cutting stapler is better than that of conventional tracheoesophageal fistula. Do not repair the advantages of obvious, The closure of fistula is more reliable, more effective and less contaminated during operation. At the same time, it can simplify the operation process, shorten the operation time, reduce the bleeding during the operation, and effectively avoid the side injury during operation and the complications in the near and long term after operation, and the effect is positive. It is worth popularizing.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655

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