食管癌术后吻合口瘘的预防和治疗探讨

Treatment and prevention of anastomotic leakage after operation of esophageal carcinoma

目的 探讨食管癌术后吻合口瘘的原因、预防及治疗.方法 对1999年1月至2009年1月手术治疗食管癌1076例进行回顾性分析,术后发生确诊吻合口瘘21例,对其发生原因、治疗进行分析.结果 治愈16例,死亡5例,死亡率23.8%. 结论充分术前准备、提高操作技术和吻合技巧是预防吻合口瘘的关键,早期诊断、早期手术可提高生存率,保持胸腔引流管通畅、持续胃肠减压。

Objective To discuss the reason, therapy and prevention of anastomotic leakage after operation of esophageal carcinoma. Methods 1076 patients with esophageal carcinoma from Jan. 1999 to Jan. 2009 were analyzed retrospectively, and 21 patients were diagnosed as having anastomotic leakage. The reason,therapy and prevention of anastomotic leakage after esophagectomy were studied. Resuits Sixteen patients were healed after treatment, and there were 5 deaths with the mortality rate being 23.8%. Conclusion Sufficient preparation before operation, and operation and anastomotic skills are the key to prevent anastomotie leakage. Early diagnosis and surgical operation can raise survival rate. Keeping intrathoracic drain tube to be unobstructed, continuing gastrointestinal decompression and nutritional support from duodenum nutrient canal are the key to treatment.