胃癌术后十二指肠残端瘘的综合治疗

The Comprehensive Treatment to Duodenal Stump Leakage of Post-operative Gastric Carcinoma

目的:总结胃癌术后十二指肠残端瘘的发病原因和诊治经验,以促进预防胃癌术后十二指肠残端瘘的发生,提高瘘发生后的诊治水平。方法:对2004年1月至2009年1月我院收治的8例胃癌术后十二指肠残端瘘患者进行回顾性分析,保留腹腔引流管者采取胃肠减压、抗感染、给予生长抑素、抑酸、营养支持等保守治疗,如引流不畅或未保留腹腔引流管者则果断二次手术、重新建立引流。结果:8例患者中二次手术2例,保守治疗6例,最终全部治愈,无死亡病例。治疗时间(16～34)天,平均26天。结论:十二指肠残端瘘通过多方面综合治疗可获得满意疗效,其中术后不过早拔除引流管、瘘发生时有通畅的腹腔引流是关键。

Objective：To summarize the pathogenisis and the experiences in diagnosis and treatment of duodenal stump leakage of gastric carcinoma.Methods：Retrospectively analyse total 8 duodenal stump leakage patients of post-operative gastric carcinoma ftom Jan 2004 to Jan 2009.Keeping abdominal cavity drainage patients were treated with gastrointestinal decompression,antibacterial,somatostatin,acid inhibitor,TPN,et al.If drainage was obstructed or no drainage,the second laparotomy were made decidedly to rebuilt a drainage.Results：Two cases were operated again and six cases were conservatively treated.All cases were healed.No case was died.Treating time lasted from 16 days to 34 days,mean time 26 days.Conclusion：Duodenal stump leakage could obtain a satisfying curative effect by integrative treatment.Don’t remove the drainage too early after operation and assure a gliding drainage was kept as leakage occurred was the key point.