食管胃吻合后胸胃瘘的外科治疗

Surgical therapy for perforation of intrathoracic stomach after esophagogastrostomy

目的探讨食管胃吻合后胸胃瘘的外科治疗及防治措施。方法回顾分析11例食管胃吻合后胸胃瘘的病人临床资料,对胸胃瘘的可能原因、诊断及外科治疗方法作进一步分析。结果该组仅4例初诊为胸胃瘘,其余均误诊为吻合口瘘。2例经定位引流治愈;9例早期行二次开胸手术治疗,分别行单纯修补、坏死穿孔部分切除和食管外置等手术;所有病例均行空肠造口术。该组无手术死亡,均治愈出院。结论食管胃吻合后胸胃瘘多因手术操作不当,造成胃壁局部血运障碍所致,关键在于预防。一旦经临床诊断,均应及时定位引流,必要时二次开胸手术,同期空肠造口术以提供早期肠为营养。

[Objective] To discuss prevention and surgical therapy for perforation of intrathoracic stomach after esophagogastrostomy. [Methods] Eleven intrathoracic stomach perforations, who had undergone esophagogastrostomy, were included in the study. We retrospectively analyzed the reasons of perforation, diagnosis and therapy of these patients. [Results] Only four of eleven were diagnosed as intrathoracic stomach perforation before operative treatmen4 and the rest misdiagnosed as anastomotic leaks. All patients were managed surgically： 7 cases had repaired with soft tissue, one case had resected the necrotic tissue around the perforation and underwent esophagogastrostomy again; one case was exteriorized esophagus of neck and put closed gastric stump back abdomen. 2 cases were cured by located drainage tube. All cases had underwent jejunostomy for early enteral nutrition at the same time. All patients in this team were cured. [Conclusion] The reasons of intrathoracic stomach perforation mainly are related with nonstandard surgical manipulation, so prevention is important. Once the diagnosis is established, reoperation should be carried out immediately.