食管癌颈部吻合术后吻合口瘘的调查研究

发布时间：2018-05-21 13:40

本文选题：食管癌 + 吻合口瘘　；参考：《医药论坛杂志》2017年02期

【摘要】：目的调查食管癌颈部吻合术后并发吻合口瘘的发病及预后情况,总结其处理方法、原则。方法分析同一术者于2013年1月—2014年12月连续进行的403例接受颈部机械吻合的食管癌患者,统计、分析吻合口瘘的发生及处理。结果所有患者均成功治愈,单纯颈部瘘患者均应用切口内负压引流方法治疗,7例(63%)患者均于2周内痊愈,平均治愈时间为18.2 d。纵隔瘘患者均经颈部切口或胃镜下放置负压引流管至纵隔瘘腔内持续负压吸引,平均治愈时间为46.5 d。73%的吻合口瘘出现在术后7 d以后,出现胃壁坏死的为12例,约占80%。12例是通过颈部触诊发现,3例在X线透视下发现。7例患者未放置胃肠减压,且均于3周内愈合。吻合口瘘患者发生吻合口狭窄比率为30%,发生率远高于未发生吻合口瘘患者的4%(P0.05)。结论食管癌颈部吻合方式安全可靠,但过分包埋反而会增加瘘的几率;颈部触诊是发现瘘简单、准确的方法;负压引流方法治疗吻合口瘘安全、有效。
[Abstract]:Objective to investigate the incidence and prognosis of anastomotic fistula after cervical esophagogastric anastomosis in the esophagus, and summarize the treatment methods and principles. Methods 403 patients with esophageal cancer undergoing neck mechanical anastomosis in the same operation from January 2013 to December 2014 were analyzed. Statistics, analysis of the occurrence and treatment of anastomotic fistula. Results all patients were successful. All patients with simple neck fistula were treated with negative pressure drainage in the incision, 7 cases (63%) were all healed within 2 weeks. The average cure time was 18.2 D. of the septum fistula, the negative pressure drainage tube was placed under the neck incision or the gastroscopy to the persistent negative pressure in the mediastinal fistula. The average cure time was 46.5 d.73% and the anastomotic fistula appeared 7 after the operation. After D, 12 cases of gastric wall necrosis were found, about 80%.12 cases were found through cervical palpation, and 3 cases of.7 patients were found to have no gastrointestinal decompression and were healed within 3 weeks under X-ray fluoroscopy. The rate of anastomotic stenosis in anastomotic fistula patients was 30%, and the incidence was much higher than that of no anastomotic fistula (4% (P0.05)). Conclusion the neck kiss of the esophagus cancer. It is safe and reliable, but excessive embedding will increase the risk of fistula; cervical palpation is a simple and accurate method to discover fistula; negative pressure drainage is safe and effective in the treatment of anastomotic fistula.
【作者单位】：安阳市肿瘤医院;
【分类号】：R735.1

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