结肠代食管术后吻合口瘘的防治

The prevention of anastomotic leakage after esophageal replacement with colon

目的探讨结肠代食管术后颈部吻合口瘘的原因和防治措施。方法统计分析572例结肠代食管的临床资料,分析不同时期吻合瘘发生率。结果初期、中期及近期阶段的吻合口瘘发生率为13.0%、12.6%和5.0%;术后并发症率为20.8%、15.5%和8.8%。结论影响吻合口愈合的因素为:①移植结肠段的主要供血管选择,是否血供充分;②局部污染程度及吻合技术,强调一层缝合;③全身综合性因素:纠正高血压、高血脂、高血凝及低血钾、低蛋白血症,围术期不输血或少输血。

Objective To explore the pathogenesis and the prevention of anastomotic leakage in the cervical region after esophageal replacement with colon(ERC). Methods Clinical data of 572 cases received ERC were analyzed retrospectively and the incidence of anastomotic leakage was also done among different periods. Results The incidence of anastomotic leakage was 13.0%, 12.6%, 5.0%, and the postoperative complication rate was 20.8%, 15.5%, 8.8% during 1962-1983, 1984-1994 and 1995-2002 respectively. Conclusions The main preventional managements of anastomic leakage are fully blood supply maintenance for the colon graft, a slight anastomosis contamination and singl e- layer anastomosis. The negative factors on the healing of the anastomosis include systemic diseases, such as hyperlipemia, hypoproteinemia et al.