食管癌术后颈部吻合口后壁瘘的临床分析

Clinical analysis of posterior cervical anastomotic leakage after radical esophagectomy

目的探讨食管癌术后颈部吻合口后壁瘘的临床特点及治疗对策。方法回顾性分析安阳市肿瘤医院胸三科2007年1月至2015年12月食管癌切除术后发生颈部吻合口后壁瘘患者的临床资料。结果共1 623例患者行食管癌根治术并行颈部器械吻合,其中左颈、左胸两切口手术入路1 182例,右颈、右胸及上腹三切口手术入路425例,左颈、上腹两切口手术入路(食管拔脱术)16例。发生吻合口瘘共82例(5.1%,82/1 623),其中后壁瘘15例(0.9%,15/1 623)。15例中瘘入纵隔2例,瘘入胸腔2例,局限于颈部11例。采用保守方法治愈14例,1例未愈。结论后壁瘘发生的原因主要是吻合器型号选择过大或吻合口张力过大;治疗应个体化。有效引流非常重要。

Objective To analyze the clinical characteristics and managements of posterior cervicalanastomotic leakage after radical esophagectomy. Methods There were 1 623 esophageal cancer patients under.went radical esophagectomy in Anyang Tumor Hospital from January 2007 to December 2015. Of them, 82 pa.tients developed posterior cervical anastomotic leakage and there clinical data were analyzed retrospectively. Results All the 1 623 patients underwent successful operations, including 1 182 with Sweet operation, 425 withMckeown operation and 16 with transhiatal esophagectomy. There were 82 cases of anastomotic leakage （5. 1%,82 / 1 623）, with 15 cases （0. 9%, 15 / 1 623） in patients with posterior leakage. Two cases were leaked intothe mediastinum, while 2 cases into the thorax, and 11 cases were confined to the neck. Both of them were trea.ted with conservative methods, 14 cases were eventually cured and 1 was failed. Conclusions The main reasonof posterior cervical anastomotic leakage after radical esophagectomy is the option of stapling device or the ten.sion of the anastomosis. Treatment should be individualized. Effective drainage is a top priority.