进展期胃上部癌应用吻合器切除术后吻合口漏的原因及对策

The causes and management of postoperative anastomotle fistula after stapling resection of advanced proximal gastric cancer

目的探讨进展期胃上部癌应用吻合器切除术后出现吻合口漏的原因及防治对策。方法回顾分析我院自2004年1月－2009年6月共113例应用吻合器作进展期胃上部癌切除术的临床资料。结果术后并发吻合口漏13例，经治疗2～4周治愈。随访6个月～5年，本组全部病例未见癌复发。4例术后出现吻合口狭窄，经作吻合口扩张术，可进食半流质饮食。结论应用吻合器作进展期胃上部癌切除，术后并发吻合口漏是最严重的并发症，原因较多，只要及时发现，通过抗感染，尤其是保持腹腔引流通畅，应用十二指肠（空肠）营养管加强肠内营养等治疗，吻合口漏多可以治愈。

Objective To explore the causes and management of postoperative anastomotic fistula after stapling resection of advanced proximal gastric cancer. Methods The data on l 13 patients receiving stapling resection of advanced proximal gastric cancer in our hospital from January 2004 to June 2009 were retrospectively analyzed. Results Anastomotic fistula occurred in 13 patients but was cured after 2-4 weeks of treatment. No recurrence was found during 6 months to 5 years of follow-up. 4 patients developed anastomotic stenosis but could take semi-liquid foods after anastomotic dilatation. Conclusions in stapling resection of advanced proximal gastric cancer, postoperative anastomotic fistula is the most serious complication due to many reasons. By prompt management, anti-infection treatment, peritoneal drainage, and application of duodenal nutrients to enhance enteral nutrition therapy, anastomotic fistula can be cured.