共查询到19条相似文献,搜索用时 78 毫秒
1.
2.
我院2003年1月~2007年12月行食管癌切除后经食管床颈部食管胃吻合243例,并发吻合口瘘12例(4.9%),报道如下。 相似文献
3.
4.
食管癌贲门癌术后吻合口瘘的预防 总被引:32,自引:1,他引:31
为降低食管贲门癌术后吻合口瘘的发生率,应用深浅间隔进针哈合法或附加大网膜覆盖术,连续施行食管癌贲门癌切除584例,无吻合口瘘。说明此法对食管胃吻合口瘘及胸胃穿孔有较好的预防作用。 相似文献
5.
食管癌术后吻合口瘘的预防 总被引:1,自引:0,他引:1
胸内食管胃吻合口瘘是食管癌根治术中最严重的并发症之一,其发病率平均为5%~10%,死亡率可高达28.5%~71%。吻合口瘘发生率的高低与手术方式、方法、技术等有一定的关系,颈部吻合比胸内吻合瘘的发生率高数倍。1999年9月~2003年8月,应用国产吻合器(WGW-2—26型)连续施行食管癌及食管胃胸内吻合术33例,无吻合口瘘发生,疗效满意。现报告如下。 相似文献
6.
7.
目的 探讨预防先天性食管闭锁术后并发吻合口狭窄的措施与临床效果.方法 对49例新生儿先天性食管闭锁患儿在手术中预先留置双腔气囊导尿管做食管支架,术后早期做引流,然后做营养管及预防性扩张用,观察预防吻合口狭窄的效果.结果 49例新生儿先天性食管闭锁术后3个月内发生吻合口狭窄6例,发生率12.24%,未增加其他并发症的发生.结论 术中预先留置双腔气囊导尿管用于预防食管闭锁术后吻合口狭窄具有良好的效果,减少第二次手术率,降低了患者费用,提高患儿生存质量. 相似文献
8.
目的 探讨食管癌及贲门癌术后胸内吻合口瘘的诊断及治疗方法.方法 分析我院2001年1 月至2010年12月2583例行食管癌、贲门癌术后发生胸内吻合口瘘19例患者的临床资料.结果 本组吻合口瘘发生率为0.74%,死亡率15.8%.确诊时间平均术后10d.接受手术治疗9例(治愈6例),保守治疗10例(治愈8例).手术治疗组平均住院时间79.4d,保守治疗组为70.5 d.手术治疗组与保守治疗组在治愈率和平均住院时间方面差异均无统计学意义(P=0.09,P=0.63).结论胸内吻合口瘘有较高死亡率.一旦确诊或高度怀疑吻合口瘘发生,应积极根据患者情况个体化选择合理的治疗方法.无论是手术治疗还是保守治疗,充分引流、有效冲洗和营养支持治疗均很重要. 相似文献
9.
目的探讨造口袋在食管癌术后颈部吻合口瘘临床应用中的效果。方法随机选择食管癌术后颈部吻合口瘘患者40例,分为实验组和对照组,各20例。实验组采用在颈部瘘口周围放置造口袋进行引流治疗,对照组采用瘘口处置引流管接负压器引流,比较2组的住院时间、换药次数和换药费用的差异。结果实验组的住院天数、换药次数、换药费用均低于对照组,差异有统计学意义。结论在食管癌术后吻合口瘘治疗中应用造口袋,可以减轻医生的工作量,缩短住院时间,减少换药费用,同时减轻患者的心理和经济负担,使患者舒适度、满意度提高,值得临床推广。 相似文献
10.
目的 探讨食管胃颈部吻合术后颈部吻合口瘘导致脓胸的发生特点及处理对策.方法 对2006年1月至2013年1月间河南省安阳肿瘤医院胸外科施行食管癌切除颈部吻合术患者的临床资料进行回顾性分析.结果 全组共计3342例食管癌患者行食管胃颈部吻合术,其中左颈左胸二切口2248例(左颈左胸术组),右胸三切口1094例(右胸术组).术后共计发生颈部吻合口瘘237例(7.1%,237/3342),左颈左胸术组152例(6.8%),右胸术组85例(7.8%),差异无统计学意义 (P=0.287).19例患者引致脓胸(8.0%,19/237),左颈左胸术组3例(2.0%),右胸术组16例(18.8%),差异有统计学意义 (P<0.01).脓胸发生在3d以内者14例(73.7%,14/19).19例脓胸患者均采用保守治疗,包括行胸腔闭式引流,经鼻腔放置十二指肠营养管或通过空肠造瘘管予以肠内营养支持治疗,并辅以肠外营养支持及抗炎对症治疗.最终治愈16例,死亡3例.结论 右侧开胸手术后发生颈部吻合口瘘易导致脓胸.充分引流及良好的营养支持是治疗的重点. 相似文献
11.
Martin Rutegård Pernilla Lagergren Ioannis Rouvelas Jesper Lagergren 《Annals of surgical oncology》2012,19(1):99-103
Background
Results are conflicting and no population-based studies are available regarding the postoperative mortality after intrathoracic anastomotic leakage. The current study addressed the unselected and independent fatality rate of intrathoracic esophageal anastomotic leaks after resection for cancer. 相似文献12.
Cong Zhi-jie Fu Chuan-gang Wang Han-tao Liu Lian-jie Zhang Wei Wang Hao 《World journal of surgery》2009,33(6):1292-1297
Background The aim of the present study was to analyze the factors associated with anastomotic leakage after anterior resection for rectal
cancer.
Methods Retrospectively collected consecutive data of 738 rectal cancer patients who underwent anterior resection in our hospital
between 2005 and 2008 were reviewed. The associations between 15 patient-related and surgery-related variables and anastomotic
leakage were studied with both the univariate chi-square test and multivariate logistic regression analysis.
Results Univariate analysis showed that risk factors associated with anastomotic leakage were low rectal cancer (located 5 cm or less
above the dentate line) (5.9% vs. 0.9%; P = 0.003), non-specialized surgeon (3.9% vs. 11.3%; P = 0.031), and defunctioning transanal catheter placement (14.5% vs. 3.6%; P < 0.001). It should be noted that the mean surgeon case volumes of anterior resection of colorectal surgeons and non-specialized
general surgeons were 43 per year and 2 per year, respectively (P < 0.001). In addition, there was a tendency for colorectal surgeons to operate on a greater proportion of low rectal cancers
(72.1% vs. 52.8%; P = 0.003). In the multivariate analysis, besides low rectal cancer, non-specialized surgeon, and transanal catheter placement,
three other factors were associated with anastomotic leakage: diabetes mellitus (P = 0.027), free distal margins less than 1 cm (P = 0.009), and a defunctioning stoma (P = 0.031). In a further analysis of 522 patients with low rectal cancer, the leakage rate in patients with a defunctioning
stoma was significantly lower (2.9% vs. 8.5%; P = 0.007). By contrast, the leakage rate in the transanal catheter placement group was higher (15.1% vs. 4.9%; P = 0.008), because of its poor protective effect as well as the selection bias.
Conclusions From the findings of this study, we believe that low rectal cancer, non-specialized surgeons, and diabetes mellitus are risk
factors for anastomotic leakage after rectal surgery, and that a defunctioning stoma could significantly reduce the incidence
of leakage in low rectal cancer patients. 相似文献
13.
14.
Elyamani Fouda Ayman El Nakeeb Alaa Magdy Enas A. Hammad Gamal Othman Mohamed Farid 《Journal of gastrointestinal surgery》2011,15(1):137-144
Background
Colorectal anastomotic leakage is a serious complication leading to major postoperative morbidity and mortality. In the present study, we investigated the early detection of anastomotic leakage before its clinical presentation. 相似文献15.
Background
Contrasting findings on trends and determinants of operative mortality after surgery for esophageal and gastric cancer have been reported from population-based studies.Methods
Discharge records of residents in the Veneto Region (northeastern Italy) with a diagnosis of esophageal or gastric cancer and intervention codes for esophagectomy or gastrectomy were extracted for the years 2000–2009. In-hospital, 30-day, 90-day, and perioperative (30-day?+?in-hospital) mortality were computed. The influence of patient and hospital variables on in-hospital mortality was assessed through multilevel models.Results
Overall, 6,500 resections were performed in the period of 2000–2009, with a 10?% decline in the second half of the study period. In-hospital mortality was 4.6?% (5.3?% in 2000–2004 and 3.8?% in 2005–2009) and was higher for extended total gastrectomy and total esophagectomy. In 2005–2009 mortality declined for all resection types except extended total gastrectomy (8.0?%). For esophageal procedures, 30-day mortality was lower than in-hospital or perioperative mortality. A protective effect of procedural volume was found for esophageal but not for gastric resections; among gastric procedures, mortality was higher in male patients and in extended total gastrectomy patients.Conclusions
Analyses of discharge records allowed investigation at a population level of time trends (downward mainly for esophageal resections) and determinants of perioperative mortality (hospital volume, gender, and procedure type). 相似文献16.
直肠癌超低位前切除术吻合口漏预防方法的探讨 总被引:1,自引:1,他引:0
目的探讨直肠癌超低位前切除术吻合口漏的原因及对策。方法2002年1月~2003年12月采用常规方法行双吻合器直肠癌超低位前切除11例(对照组),2004年1月~2005年11月采用改良技术行双吻器直肠癌超低位前切除术31例(改良组),术中行会阴助推,注意吻合器穿刺头穿刺点的选择,行远侧直肠密闭试验及吻合口压力试验,经肛门置管至吻合口以上,骶前放置引流管经腹壁引出。结果对照组发生吻合口漏2例,经横结肠造瘘或保守治疗治愈。改良组无吻合口漏,其会阴助推方法显示盆腔直肠的长度平均增加3 cm;远侧直肠密闭试验阳性6例,均经缝合后消除,吻合口漏气4例,其中3例经缝合后消除,另1例因位置太低无法缝合而行预防性回肠造瘘,术后未发生吻合口漏。结论会阴助推、注意吻合器穿刺头穿刺点的选择、远侧直肠密闭试验与吻合口压力试验在双吻合器直肠癌超低位前切除术中的应用,对预防吻合口漏有一定的帮助。 相似文献
17.
Background
Anastomotic complications after low anterior resection are associated with perianastomotic ischemia. Smoking is one of the main causes of microvascular disease that is correlated with tissue ischemia. The purpose of the present study was to assess the impact of smoking on anastomotic complications after low anterior resection in rectal cancer patients. 相似文献18.
Yukiharu Hiyoshi Naoya Yoshida Masayuki Watanabe Junji Kurashige Ryuichi Karashima Shiro Iwagami Yoshifumi Baba Hideo Baba 《World journal of surgery》2016,40(4):913-920