37例食管癌和贲门癌切除术后吻合口瘘临床分析

Clinical analysis of 37 cases anastomotic fistula after resection of carcinoma of esophagus and cardia

目的:探讨食管癌、贲门癌切除术后发生吻合口瘘的原因及吻合口瘘的诊断和治疗方法。方法:对1452例食管癌、贲门癌切除术的临床资料进行回顾性分析。1452例术后发生吻合口瘘37例,颈部吻合口瘘16例均行保守治疗,胸部吻合口瘘21例,保守治疗17例,再次开胸手术治疗4例。结果:37例吻合口瘘治愈30例,死亡7例(23.33%),颈部瘘16例全部治愈。胸内瘘21例保守治疗17例,治愈12例(70.59%),死亡5例(29.41%),2例二次瘘口修补,治愈1例(50.00%),死亡1例(50.00%),2例二次吻合口切除再吻合,治愈1例(50.00%),死亡1例(50.00%)。结论:手术操作技术和肿瘤大小、部位及吻合口张力是影响吻合口愈合的重要的因素,应及时诊断和处理吻合口瘘,根据病情尽早争取再次手术或保守治疗是治疗成功的关键。

Objective： To investigate the cause, diagnosis and treatment of the anastomotic fistula after esophageal cancer and cardia cancer resection. Methods： Clinical data of 1 452 patients were analysed retrospectively. These patients were resected of carcinoma of esophageal and cardia from January 1985 to October 2004. Results： Anastomotic fistula were found in 37 cases out of 1 452, 30 cases were cured and 7 died （23.33%）. Among the total cervical fistula were 16 cases. All of them were cured. Internal of thoracic fistula were 21 cases, 17 cases accepted expectant treatment, 12 cases were cured（70.59%） and 7 died （29.41%）, 2 cases were reoprated to repair orifieium fistulae, 1 case was cured（50.00%） and 1 died （50.00%）, 2 cases were reoprated to resect stoma reanastomosis, 1 cases was cured（50.00%） and 1 died （50.00%）. Conclusion： Procerdure technique, lesion location, amplitude and situation of anastomotic stoma are predominant perfect anastomotic heal reason. Early diagnosis and treatment are keys of succeeded treatment.