食管贲门癌切除术后并发食管胃大动脉瘘18例分析

Fatal esophagogastric-arterial fistula following resection for carcinoma of the esophagus and cardia

目的探讨食管癌贲门癌术后发生食管胃大动脉瘘的病因、诊断治疗方法与预防措施。方法对18例术后食管胃大动脉瘘的临床资料进行回顾性分析。结果其中食管癌14例(食管中段癌7例,下段癌7例)、贲门癌4例。食管胃弓上吻合术的7例(其中2例胸顶吻合),食管胃弓下吻合术的11例(其中4例弓窝吻合)。手术至出血发生时间最短的11d,最长的93d。1例再次手术行瘘修补术后生存18d。18例全部死亡。结论食管贲门癌应采用手术治疗,但手术方法值得探讨。避免吻合口瘘和食管胃消化性溃疡穿孔才能预防食管胃大动脉瘘的发生。

Objective To study the pathogenesis, clinical symptoms, surgical treatment and preventive measures of esophagogastric-arterial fistula following resection for carcinoma of the esophagus and cardia. Methods The clinical data of 18 patients with esophagogastric-arterial fistula were retrospective analyzed. Results There were 14 patients of esophageal carcinoma and 4 patients of cardiac carcinoma.7 patients had supra-aortic esophagogastric anastomosis（2 near the apex of pleura） and 11 had anastomosis under the aortic arch. Fatal hemorrhage occurred postoperatively from 11 to 93 days. The interval between hemorrhage and death varied from being instant to 18 days.All patients died. Conclusion The surgical treatment provide an opportunity for those patients. Successful management is possible if early diagnosis is made and prompt surgical management is undertaken. Preventive measures of peptic ulcer and esophageal fistula can decrease occurrence of this complication.