食管癌贲门癌术后吻合口及胸胃瘘的临床分析

Clinical analysis of anastomotic and thoracic gastric leakage after resection of esophageal and gastric cardial carcinoma

目的 探讨食管癌、贲门癌切除术后吻合口及胸胃瘘发生的高危因素及防治措施。方法 分析 1990年 1月～ 2 0 0 3年 12月间 136 9例行食管癌、贲门癌切除、食管重建术病人的临床资料。结果 本组颈部吻合口瘘的发生率为 16 .2 4 %。胸内吻合口及胃瘘发生率为 2 .0 % ,死亡率2 8.0 % ;前 6年和近 7年相比 ,胸内瘘的发生率为 3.33%对 1.4 6 % (P =0 .0 31)。胸内机械吻合瘘的发生率为 0 .5 1%。结论 吻合口瘘及胸胃瘘是食管重建术后严重的并发症 ,应用机械吻合。

Objective To explore the risk factors of anastomoti c and thoracic gastric leakage after the resection of esophageal carcinoma and gastric cardial carcinoma, and discuss its possible preventive and therapeutic methods. Methods A retrospecive analysis of clinical data of 1 369 patie nts undergoing esophageal resection and reconstruction between January 1990 and December 2003 was made. Results The incidence of anastomotic leakage in the cervical anastomosis was 16.24%. The intrathoracic anastomotic leakage and thoracic gastric leakage occurred in 23 patients with an overall incidence of 2.0% and a mortality of 28.0%. There was significant difference in the incidence of t horacic leakage before and after 1996 (3.33% vs 1.46%, P=0.031). And the incidence of the leakage in 590 patients who accepted surgical procedures of esophageal reconstruction with circular stapling devices intrathoracically was 0.51%. Conclusions Anastomotic and thoracic gastric leakage are consid ered to be more serious complications associated with esophageal reconstruction. The clinical experience indicates that for reducing the incidence of anastomotic and thoracic gastric leakage, using circular staplers in intrathorac ic esophagogastroanastomosis, mastering the anastomosis technique and improving the perioperative management are the key points.