食管癌术后胸内瘘11例临床分析

Clinical Analysis of 11 Cases of Intrathoracic Fistula after Transthoracic Esophagectomy

目的分析食管癌术后胸内吻合口瘘的原因,探讨吻合口瘘的预防及治疗。方法回顾性分析安康市中医医院2001年1月～2010年12月行食管癌根治胸、颈部吻合术302例临床病例,总结食管癌术后胸内瘘发生的原因、诊断、治疗及预防。结果全组302例发生胸内瘘11例,发生率为3.64%,其中胸内吻合口瘘8例,胸内胃瘘3例。治愈10例(90.9%)。结论本组病例手术分为食管壁内吻合及吻合器吻合两种方式,发生胸内瘘的主要原因为胃管引流不畅、消化道残端关闭器使用不当、胸腔积液及肺部感染,早期处理是关键,通过非手术治疗可以达到满意的治疗效果。

Objective To analyze the cause of intrathoracic fistula after transthoracic esophagectomy, and explore the prevention and treatment of anastomotie fistula. Methods A retrospective analysis was compiled of 302 patients undergoing radical esophageal anastomosis in chest and neck during the period from January 2001 to December 2010. The pathogeny, diagnosis, treatment and prevention of intrathorac- ic fistula were summarized after esophagectomy. Results The intrathoracic fistula occurred in 11 patients with an overall incidence of 3.64%. Among them intrathoracic anastomotic fistula was in 8 patients, tho- racic gastric fistula in 3. Ten patients were cured （90.9%）. Conclusion The main causes of intratho- ratio fistula are stack nasogastric drainage, gastrointetinal stump closure for improper use, elimination of pleural effusion and pulmonary infections. Early treatment is the key. Nonoperative treatment can achieve satisfactory therapeutic effect.