带蒂大网膜对食管癌胸内吻合口瘘作用的临床分析

Clinical analysis of use of pedicled greater omentum for intrathoracic anastomotic fistula after resection of esophageal carcinoma

目的 探讨带蒂大网膜覆盖包绕吻合口对食管癌术后胸内吻合口瘘的作用.方法 将食管癌根治性切除食管胃弓上吻合术加带蒂大网膜覆盖包绕吻合口的102例患者作为治疗组,将行食管癌根治性切除食管胃弓上吻合术的113例作为对照组,对两组发生吻合口瘘的情况进行比较分析.结果 两组患者均顺利完成手术.治疗组发生吻合口瘘3例（2.94%）,对照组发生吻合口瘘5例（4.42%）.两组病例吻合口瘘发生率差异无统计学意义（P＞0.05）.治疗组发生吻合口瘘病例的临床症状较对照组轻.结论 带蒂大网膜覆盖包绕吻合口对食管癌术后胸内吻合口瘘无明显预防作用,但是对减轻发生吻合口瘘后的临床症状有明显作用,有助于吻合口瘘的后续治疗,值得推广.

Objective To discuss the use of pedicled greater omentum forintrathoracic anastomotic fistula after radical resection of esophageal carcinoma. Methods Patients received resection of esophageal carcinoma were divided into two groups. The control group was consisted of patients receiving radical resection of esophageal carcinoma and supra-arch esophagogastric anastomosis. The treatment group includ- ed patients receiving additional operation of covering anastomosis with pedicled greater omentum. The clini- cal data of anastomotic fistula were compared and analyzed between the two groups. Results All surgeries were successfully performed. There were 3 cases of anastomotic fistula in the treatment group and 5 cases in the control group. The difference of fistula incidence between the two groups was not significant, but the clinical symptoms of fistula in the treatment group were slighter compared with the control group. Conclusion Covering anastomosis with pedicled omentum has no significant preventive value for intrathoracic fistula, but it is worth the clinical promotion because it can ease clinical symptoms of fistula significantly and is good for follow-up treatment.