胃镜辅助新三管法治疗严重胸内食管胃吻合口瘘

Gastroscopy - aided new three - tube method for treatment of major intrathoracic esophagogastric anastomotic leakage

目的探讨胃镜辅助新三管法治疗食管切除术后严重胸内食管胃吻合口瘘的价值。方法对13例胸内食管胃吻合口瘘（瘘口直径≥1．0cm）的患者，在胃镜辅助下经鼻置人瘘腔引流管，行负压吸引，充分引流脓液，同时配合胸腔引流管行闭式引流，鼻肠管行肠内营养支持。结果所有患者均一次置管成功，置管时间为5～9min，平均6min。12例患者痊愈，瘘口愈合时间16～78d，平均31．4d。1例患者死于严重肺部感染。结论胃镜辅助新三管法治疗严重胸内食管胃吻合口瘘安全、有效、经济。

Objective To evaluate the efficacy of gastroscopy aided new three -tube method for treatment of major intrathoracic esophagogastric anastomotic leakage. Methods In 13 patients with confirmed intrathoracic gastroesophageal anastomotic leakage （ fistula diameter ≥ 1.0 cm ） , under the gastroscopic guidance, the drainage tube of fistula cavity was inserted through nasal cavity in order to exert a complete drainage effect, with simultaneously retaining the negative pressure drainage tube of thoracic cavity and the nutritious tube of jejunum. Results The drainage tube of fistula cavity was placed once suc- cessfully in all 13 patients, with procedure duration from 5 to 9 min （mean,6 min）for each patient. Of the 13 patients, 12 were cured after 16 -78 days（ mean 31.4 days）and 1 died because of a progressive pneumonia. Conclusion Gastroseopy - aided new three - tube method is safe, effective and economic in treatment of major intrathoracic gastroesophageal anastomotic leakage.