Nigeiqianlm胃镜引导下放置十二指肠营养管治疗食管癌术后吻合口瘘的临床效果及应用体会

Clinical Effect and Experience of Application of Gastroscope Placed Duodenal Feeding Tube on Esophageal Cancer Postoperative Anastomotic Leakage

目的:探讨胃镜引导下置入十二指肠营养管治疗食管癌术后并发吻合口瘘的临床效果及其应用体会。方法:在2008年1月至2011年9月入我科治疗的3126例食管癌手术患者中,49例术后并发吻合口瘘,患者经胃镜引导下置营养管于十二指肠降部,给予肠内营养治疗。术前1天、术后第5天、第7天、出院时分别测定患者体重,术后第1天起逐日观察患者肛门排气、排便等胃肠功能恢复情况。结果:49例患者中首次置管成功47例,成功率96%,置管时间10～20min,平均12min,置管及术后未发生严重并发症;鼻肠营养管肠内营养术后第7天体重下降≤2kg;肠道功能恢复快,术后肛门排气时间≤3d。结论:置入营养管的长度要较胃镜观察长约20cm并妥善固定可提高首次置管成功率。胃镜引导下置入十二指肠营养管对食管癌术后并发吻合口瘘的患者是一种安全、方便、有效的肠内营养途径,对此类患者的营养治疗起重要支持作用,具有临床应用价值。

Objective： To investigate the the gastroscope duodenum feeding tube placement and treatment of esophageal cancer postoperative anastomotic leakage in value. Methods： From January 2007 to September 2010 3126 cases of esophageal cancer surgery patients, 49 patients with esophageal cancer postoperative set anastomotic leakage in patients with gastroscopy under the guidance of the feeding tube in the descending＇duodenum, enteral nutrition therapy. Patients＇ weight were measured in one day before surgery, five days after the first 7 days, and at discharged fi＇om hospital. Flatus, defecation and gastrointestinal function were observed daily from the first day after surgery. Results： 49 patients for the first time home tube success of the 49 cases, the success rate of 100%, catheter time 10-20min, an average of 12min, the catheter and postoperative no serious complications. Weight loss was less than 2kg seventh days after operation. Faster recovery of bowel function was found. Flatus was less than 3 days. Conclusion： Feeding tube should length than the gastroscope observation about 20cm and properly secured, which can increase the success rate of tube for the first time. The gastroscope placed duodenal feeding tube in patients with anastomotic fistula after esophagectomy is a safe, convenient, effective enteral nutrition means to play an important role in the nutritional treatment of such patients. This method had wide range of clinical value.