胃癌根治术后并发胃肠道瘘的诊治:附15例报告

Diagnosis and Treatment of Gastrointestinal Fistula after Radical Gastrectomy:Fifteen Cases Report

目的:探讨胃癌根治术后患者并发胃肠道瘘的诊治方法。方法:回顾分析胃及软组织外科接受胃癌根治术后发生胃肠道瘘的15例患者的临床资料。结果:15例患者中4例接受再次手术行腹腔引流,11例经原引流管引流或在B超、CT引导下穿刺置管引流以及禁食、胃肠减压、空肠置管肠内营养等治疗后治愈,无患者死亡。再次手术组与未再次手术组患者的胃肠道瘘确诊后住院时间、外周血白细胞异常天数、发热天数差异均无统计学意义(P>0.05)。结论:胃癌根治术后出现胃肠道瘘后及时诊断、充分有效地引流是治愈的关键,如果指征把握恰当,穿刺置管引流等非手术治疗疗效确切,可以避免二次手术。

Objective：To investigate the diagnosis and treatment of gastrointestinal fistula after radical gastrectomy.Methods：The clinical data of 15 patients,who underwent radical gastrectomy and suffered post-surgery gastrointestinal fistula at Department of Gastric Cancer and Soft Tissue Sarcoma,Shanghai Cancer Center,Fudan University from Jan 2013 to Dec 2014,were retrospectively analyzed.Results：Four of the fifteen patients received reoperative procedures for peritoneal drainage.And the other 11 patients were cured after B ultrasound or CT imaging guided percutaneous catheter drainage and treatments such as fasting,gastrointestinal decompression,and enteral nutrition via needle catheter jejunostomy.No patient died.There was no statistically significant difference regarding length of hospital stay,leukocytes abnormal days in peripheral blood and fever days after the diagnosis of gastrointestinal fistula between the reoperation group and the non-reoperation group（P〈0.05）.Conclusions：Early diagnosis,as well as adequate and effective drainage is the key to cure for gastrointestinal fistula after radical gastrectomy.If operation indication is properly managed and nonsurgical treatment such as percutaneous catheter drainage is effective,then reoperation can be avoided.