预防全胃切除术吻合口瘘的体会

Experience in Prenvention of Anastomotic Leakage in Total Gastrectomy

１９８６．７～１９９３．１月作者为５５例胃恶性肿瘤患者做了全胃切除术，无吻合口瘘发生。预防吻合口瘘的主要体会是：１．重视围手术期处理，改善患者的全身状况；２．预防隔下感染；３．采用空肠ρ型代胃Ｙ型瓣式吻合术；４．可靠的吻合，良好的血循环，吻合口无异常张力是预防吻合口屡的关键；５．吻合器吻合可提高吻会质量；６．注意选择切口，保障显露满意、操作方便。

rom July l986 to January l993 the authors had done total gastrectomy on 55 patients with malignanttumor of the stomach,the anastomotic leakage didn't occur in any patient. Author's principal experiences inpreveption of esophago-jejunal anastomosis leakage were following. 1. Great attention should be paid to sup-portive therapy in perioperative period and improving the general condition of the patients.2.Subphrenic in-fection should be prevented,and the specific measures for this were following,(1)“preparing upper gastroin-testinal tract”,(2)avoiding contamination with gatqtric and intestinal juice,(3)completely stopping bleeding.(4)washing the peritoneal cavity before the abdomen was closed,(5)aspirating blood and fluid in the peri-toneal cavity,(6)setting an effective drainage tube under the diaphragm on the left,(7)Prophylacticly usingantibioties. 3. The rate of anastomotic leakage with jajunal p-shaped anastomosis was lower. 4. Reliable anas-tomsis,good hlood supplication and anastomosis without abnormal stretch were the key to pveventin. of anastomotic leakage . 5.Use of stapler made the esophagojunostomy more reliable. 6. It was important tochoose approach suitable for exposure and operation.