老年食管癌术后吻合口瘘的原因分析及对策

Reason Analysis and the Countermeasure of Elderly Patients with Esophageal Carcinoma Postoperative Anastomotic Leakage

目的探讨老年食管癌切除术后胸内吻合口瘘的原因分析及合理治疗方法。方法回顾我院自2000年1月至2009年12月对65例老年食管癌行左胸切口切除,胸内吻合术,术后并发胸内吻合口瘘4例,根据患者不同临床表现、胸片、B超及胸部CT结果选择治疗方法,2例行手术治疗,2例保守治疗。对治疗结果进行回顾性分析。结果全组共发生胸内吻合口瘘4例,发生率为6.1%,行保守治疗2例,死亡1例。行二次手术2例,死亡1例。病死率为50%。结论①老年食管癌术前应充分评估,严格掌握手术适应证,加强围手术期管理。②胸内吻合口瘘是食管癌术后严重的并发症和主要死亡原因。③早期诊断、恰当选择治疗方法能提高胸内吻合口瘘的疗效。④手术方法的改进和吻合技术的提高,有助于预防吻合口瘘;⑤积极应用TPN支持和胃肠内营养支持是处理胸内吻合口瘘的有效治疗方法。

Objective To explore the elderly esophageal carcinoma resection of intrathoracic anastomotic leakage reason analysis and reasonable treatment method.Methods Retrospectively in our hospital from 2000 January to 2009 December on 65 Elderly Patients with esophageal cancer resection of left thoracic incision,intrathoracic anastomosis,after resection of the intrathoracic anastomotic fistula in 4 cases,patients according to different clinical manifestations,chest X-ray,B ultrasound and chest CT findings choice method of treatment,2 were treated by operation,2 cases of conservative treatment.Results Treatment were retrospectively analyzed.Results The total occurrence of intrathoracic anastomotic fistula in 4 cases,the incidence was 6.1%,conservative treatment in 2 cases,1 cases of death.Two operation in 2 cases,1 cases of death.The mortality rate was 50%.Conclusion ①Elderly esophageal carcinoma before operation should be fully evaluated,strict operation indications,strengthen peri operation period management.②The intrathoracic anastomotic fistula after resection of esophageal cancer is a serious complication and the main cause of death.③In early diagnosis,appropriate choice of treatment method can improve the intrathoracic anastomotic fistula.④Operation method and improvement of anastomosis techniques improved,contributes to the prevention of anastomotic fistula.⑤The positive application of TPN support and enteral nutrition support treatment of intrathoracic anastomotic leakage is the effective method of treatment.