胸内食管胃吻合口瘘16例诊治分析

Diagnosis and Treatment of 16 Gastroesophageal Anastomotic Fistula

目的:探讨胸内胃食管吻合口瘘的诊断和治疗。方法:我院自1994年1月至2003年12月对353例贲门癌、食管癌行切除左胸内吻合术,术后并发吻合口瘘16例,根据患者不同临床表现、胸片、B超及胸部CT结果选择并改进治疗方法,12例选择手术治疗,4例保守治疗。对治疗结果进行回顾性分析。结果:1例高龄患者再手术后并发心衰死亡,死亡率6.25%(1/16),其余病例均治愈。2例术后再发瘘,经保守治疗痊愈,发生率16.67%(2/12)。结论:早期诊断、恰当选择和改进治疗方法能提高胸内吻合口瘘的疗效。B超和CT结合使用有助于诊断和指导治疗。

Objective：To investigate the diagnosis and treatment of gastroesophageal anastomotic fistula （GAF） in left chest. Method： Resection and gastroesophagostomy was performed in 353 patients with esophageal and cardic cancer from January 1994 to December 2003. GAF occurred postoperatively in 16 patients. The different treatment for 16 patients was choosed and improved according to individual clinic findings and results of chest X -ray, CT, B -ultrasound. Reoperation was performed in 12 patients and conservative treatment in 4. The outcome of treatment was retrospectively reviewed. Result： 1 aged patient was dead post - reoperatively with a mortality rate of 6.25% （1/16）. The cause of death was heart failure. The others were cured including 2 patient with re - fistula after reoperation through conservative treatment. The rate of re - fistula was 16.67% （2/12）. Conclusion：It can improve the outcome for the patients with GAF to diagnose early, choose and improve treatment properly. A combined use of B - ultrasound and CT is beneficial to diagnosis and guide treatment.