食管手术后急性胸胃扩张的治疗和预防

Treatment and Prophylaxis of the Acute Thoracogastric Dilation Following Esophagectomy

目的 :探讨经右胸颈腹三切口术后急性右侧胸胃扩张的治疗和预防方法。方法 :对 1例三切口术后发生急性胃扩张病人采取空肠双向置管的方法进行了治疗 ,并预防性地使用该方法于 15例三切口食管癌的病人。结果 :术后发生急性右侧胸胃扩张的病人经该方法治疗后症状立即消失 ,再次手术后 3周出院。其余 15例预防性使用的病人无一例发生胸胃扩张和吻合口瘘。结论

Objective:To investigate the reasonable approach of treatment and prophylaxis of the acute right thoracogastric dilation after esophagectomy via neck,right thorax and abdomen.Methods:The bidirectional tubes put introduced in the jejunum to treat a patient who had acute dilatation of stomach following the operation with trisincision,this approach was also used in the other 15 patients with esophageal carcinoma who under went the operation with trisincision.In operation,two orifics were made in the jejunum 18～25cm apart to Treitz lig.After the stomach had been freed,a stomach tube was positioned in the gastric atrium via duodenum and pylorus from proximal orifice,then a nutritional tube was put in the jejunum from distal orific.After operation,continuous negative pressure drainage from stomach tube was applied.After 48h,the saline,nutrient solution and gastric juice were infused via the nutritional tube,parenteral nutuition was not need.From the fifth postoperative day the intravenous transfusion was discontinued.Patients can eat by mouth and the stomach tube damped was at 14 days.If no anastomotic fistula thoracogastric,dilation occurred,patient could canceletely depended his nutrition from eating semi-solid diet by mouty,and the two tubes were withdrawn 2 days later.Results:By the approach,the symtoms and signs of acute dilatation of stomach were all disappeared immediately after the second operation,and the patient was discharged after 3 weeks.None of the other 15 patients had acute dilatation of stomach and anastomstic fistula.Conclusions:This approach was a valuable method for treatment and prophylaxis of and acute thoracogastric dilation after esophagectony