食管中上段癌经左胸切除后颈部吻合口瘘的发生原因及预防(附133例病例分析)

CAUSE AND PREVENTION OF CERVICAL ESOPHAGOGASTRIC ANASTOMOTIC FISTULA AFTER ESOPHAGECTOMY THROUGH LEFT THORAX FOR THE TREATMENT OF UPPER AND MIDDLE SECTION OF ESOPHAGEAL CANCER

目的 :探讨食管中上段癌经左胸切除后颈部吻合口瘘的发生原因及预防措施。方法 :回顾分析 1 987年 1 0月～ 2 0 0 0年 3月我科 1 33例食管中上段癌经左胸切除术 ,总结胸腔胃经主动脉弓前上提和经食管床、主动脉弓后上提左颈部胃 食管吻合术经验。结果 :1 33例中 ,发生吻合口瘘 8例 ( 6 0 % )、胸胃穿孔 2例 ( 1 5% )、切口感染 4例 ( 3 0 % )、脓胸 1例 ( 0 75% ) ,无手术死亡。结论 :降低吻合口张力 ,保证胸腔入口、主动脉弓后间隙宽畅是避免吻合口瘘发生的关键。

Objective:To investigate the cause and prevention methods of cervical esophagogastric anastomotic fistula following esophagectomy through left thorax.Methods:From Oct.1987 to March 2000 one hundred and thirty three patients underwent esophagectomy through left thorax with cervical esophagogastric anastomosis.Two ways that stomach was lifted to the neck for anastomosis were applied.One is from the anterior of aortic arch,the other is through the bed of esophagus and the space posterior of aortic arch.Results:Eight of them got cervical esophagogastric anastomotic fistula,2 cases got gastric perforation,and the rate of these two complications was 6 0% and 1 5%,respectively.Conclusion:Relieving the tension of anastomosis,enlarging the outlet of thorax and the space posterior to aortic arch are key steps for preventing anastomotic fistula.