摘要
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.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2006年第19期2934-2937,共4页
China Journal of Modern Medicine
关键词
食管胃吻合术
胸胃
穿孔
治疗
esophagogastrostomy
intrathoracic stomach
perforation
therapy.