探讨胸腹腔镜联合食管癌切除术后颈部吻合口瘘的原因及治疗方法

To explore the cause and treatment of neck anastomotic fistula after thoracic laparoscopy combined with resection of esophageal cancer

目的探究胸腹腔镜联合食管癌切除术后颈部吻合口瘘的原因及治疗方法。方法回顾性分析2017年1月至2019年12月于本院行胸腹腔镜联合食管癌切除术的150例患者的临床资料。收集患者住院期间的相关临床资料,比较颈部吻合口瘘发生率,并分析肿瘤发生位置、肿瘤分期、合并糖尿病等因素对颈部吻合口瘘的影响,比较患者的住院时间及临床治疗情况。结果150例患者中,颈部吻合口瘘14例,发生率为9.33%。胸腹腔镜联合食管癌切除术后颈部吻合口瘘的发生与肿瘤位于食管上段、肿瘤分期偏晚、合并糖尿病等因素呈正相关(P<0.05)。有颈部吻合口瘘患者的住院时间为(22.25±7.48)d,无颈部吻合口瘘患者的住院时间为(18.23±5.46)d,差异有统计学意义(t=2.170,P=0.035)。本研究未出现二次手术及死亡患者,经有效治疗后,所有患者均已顺利出院。结论胸腹腔镜联合食管癌切除术后,由于肿瘤靠上、肿瘤分期偏晚、基础疾病较多等因素的影响,会使患者出现颈部吻合口瘘,为促进颈部吻合口瘘快速愈合,避免发生其他术后并发症,应及时予以患者通畅引流、营养支持、抗感染、呼吸道干预等针对性治疗。

Objective To investigate the causes and treatment of neck anastomotic fistula after thoracic laparoscopy combined with resection of esophageal cancer.Methods Retrospective analysis was performed on the clinical data of 150 patients who underwent thoracolaparoscopic combined resection of esophageal cancer in our hospital from January 2017 to December 2019.Clinical data of patients during hospitalization were collected to compare the incidence of cervical anastomotic fistula,and to analyze the influence of tumor location,tumor stage,diabetes and other factors on cervical anastomotic fistula,and to compare the length of hospital stay and clinical treatment of patients.Results Of the 150 patients,14 cases were anastomotic fistula,with incidence of 9.33%.The incidence of cervical anastomotic fistula after thoracic laparoscopy combined with esophageal cancer resection was positively correlated with the location of tumor in the upper esophagus,the late stage of tumor,and diabetes mellitus(P<0.05).The length of hospital stay of patients with cervical anastomotic fistula was(22.25±7.48)d,and that of patients without cervical anastomotic fistula was(18.23±5.46)d,the difference was statistically significant(t=2.170,P=0.035).There was no second operation or death in this study.After effective treatment,all patients were discharged successfully.Conclusion After thoracic laparoscopy combined with resection of esophageal cancer,due to the influence of tumor upside,late tumor staging,and many underlying diseases,cervical anastomotic leakage will occur in patients.In order to promote the rapid healing of cervical anastomotic leakage and avoid other postoperative complications,targeted such as unobstructed drainage,nutritional support,anti-infection,and respiratory intervention should be given in time..