食管癌食管气管瘘的治疗工作研究

Research on Treatment Work of Esophageal Carcinoma Tracheal Esophageal Fistula

目的研究外科手术治疗食管癌食管气管瘘的技术特点以及经验,分析有效的治疗方式。方法对该院2011年9月—2015年5月期间所收治的23例食管癌食管气管瘘患者进行回顾性分析,根据患者病情的不同,将23例患者分为3组,A组6例,B组8例,C组9例,并采取3种手术方式治疗食管癌食管气管瘘,所有患者均给予食管部分切除手术,A组随后采取食管胃隧道式吻合术+肺叶切除术,B组随后采取食管胃器械吻合术+肺叶切除术,C组随后行食管胃吻合术+左全肺切除术。观察3组患者的治疗情况,对比分析3组患者的并发症发生率与死亡率。结果手术完成后,围术期死亡2例,约占8.70%,其中1例患者为食管癌并左肺下叶支气管,手术方式为食管胃隧道式吻合术+肺叶切除术,患者死亡原因为心力衰竭,死于术后第5天,另一例患者为食管癌并左肺上叶支气管,手术方式为食管胃器械吻合术+肺叶切除术,患者死于重症感染伴随肾功能衰竭,死于术后第12天。除上述2例死亡患者外,其余21例患者有6例并发轻度脓胸,约占26.08%,支气管吻合口瘘2例,约占8.70%,经引流等治疗后愈合,对21例生存患者随访1年,发现死亡1例,其余20例患者无并发症发生,无死亡。结论在食管癌食管气管瘘的治疗期间,应根据患者的病情,选择合适的手术方式,制定有效的治疗方案。

Objective To research the technical features and experience of surgical operation in treatment of esophageal carcinoma tracheal esophageal fistula and analyze the effective treatment method. Methods 23 cases of patients with esophageal carcinoma tracheal esophageal fistula admitted and treated in our hospital from September 2011 to May 2015 were reviewed and analyzed, and 23 cases of patients were divided into three groups according to the diseases, all patients were treated with partial resection of esophagus, the group A adopted the tunnel anastomosis after removal of esophageal carcinoma and lobectomia pulmonalis, the group B adopted the mechanical anastomosis after removal of esophageal carcinoma and lobectomia pulmonalis, and the group C adopted the esophagogastro-anastomosis and left to- tal pneumonectomy, and the treatment of the three groups was observed and the incidence rate of complications and death rate of the three groups were compared and analyzed. Results After operation, 2 cases died during the perioperative period, accounting for 8.70%, and 1 case died due to heart failure on the 5 d after operation, and the operation method was tunnel anastomosis after removal of esophageal carcinoma and lobeetomia pulmonalis, and 1 ease died due to severe infection with renal function failure on the 12 d after oeration and the operation method was mechanical anastomosis after removal of esophageal carcinoma and lobectomia pulmonalis, in the other 21 cases, there were 6 eases complicated by mild empyema, accounting for 26.08%, and 2 eases with bronchus anastomotic stoma fistula, accounting for 8.70%, and patients were cured after drainage, 21 cases of survival patients were followed up for 1 year, and there was 1 death case and the other 20 cases had no complications. Conclusion During the treatment period of esophageal carcinoma tracheal esophageal fistula, we should select the suitable operation method and make the effective treatment plan according to the diseases of patients.