高位食管癌切除术后颈部吻合口瘘的防治

目的探讨高位食管癌切除术后食管胃吻合口瘘的防治。方法切除高位食管癌296例，对术后并发吻合口瘘的原因和防治措施进行分析。结果全组吻合口瘘的发生率为2．0％（6／296），6例均获治愈。表明食管切除平面高，行颈部食管胃吻合难度大，吻合口有张力，血运不佳是发生吻合口瘘的主要原因。结论提高操作技术．改进手术方法，确保吻合口血运良好、无张力，可预防吻合口瘘发生。及时通畅引流，避免继发纵隔炎或脓气胸是降低吻合口瘘死亡率的重要措施。

Prevention and Treatment of Postoperative Anastomotic Leakage of High Esophageal Carcinoma

Objective To study the prevention and treatment of anastomotic leakage after re-section of high esophageal carcinoma. Method: 296 cases with high esophageal carcinoma were re-ceived excision. The cause, prevention and treatment of anastomotic leakage were analyzed. Results:The morbidity rate of anastomotic leakage in the whole group was 2. 0% (6/296). All 6 cases werecured. It was thought that the main causes of anastomotic leakage were higher resection level ofesophagus, more difficulty of gastro-esophageal anastomosis at neck, tension of anastomosis and de-ficiency of blood supply. Conclusions: Anastomotic leakage could be prevented through raising oper-ative technique, improving operative therapy, ensure blood supply well and no tension at anastomo-sis. It is the important measures to decrease death rate of anastomotic leakage that unobstructeddrainage in time, avoiding secondary mediastinitis or pyopneumothorax.