食管癌、贲门癌术后吻合口瘘的治疗体会

Treatment experience of anastomotic leakage after operation of esophageal or cardia carcinoma

目的探讨食管癌贲门癌手术切除后并发吻合口瘘的发生原因、致死因素及有效治疗措施。方法对手术切除食管癌贲门癌10860例进行回顾性分析,总结术后并发吻合口瘘的发生因素、临床表现、诊断与治疗体会。结果术后确诊并发吻合口瘘148例,除1例继发双肺感染及切口感染致感染性休克及多脏器功能衰竭死亡,余147例经治疗痊愈,死亡率0.68%。结论①吻合方式及操作技巧是术后吻合口瘘发生的主要因素之一;②感染和营养不良衰竭是主要死亡原因;③三管(胸管、胃管、营养管)畅通是治疗的关键所在。

Objective To discuss the reason, lethal factors and effective treatment on anastomotic leakage after operation of esophageal or cardia carcinoma. Methods The occurrence of the anastomotic leakage in 10 860 examples of esophageal or cardia cancer were observed. Results Anastomotic leakage is happened to 148 examples in 10 860 examples. Except 1 example with the lung infection and margin infection get infectious shock and MOF, other 147 examples were healed after treatment. The mortality rate is 0. 68% . Conclusion （1）The most important reason of anastomotic leakage is type of anastomotic procedure and operative skills. （2）The main reasons to death are infections and malnutrition. （3）Three tubes （ductus thoracicus, stomach tube ,alimentary tract） unimpeded are the key to treatment.