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71.
目的探讨镍钛记忆合金带膜内支架在治疗食管癌术后胸内吻合口瘘中的应用价值。方法在X线电视透视下对22例食管癌术后胸内吻合口瘘患者进行镍钛记忆合金带膜内支架植入治疗。结果19例一次植入成功,成功率86%,恢复正常饮食;不完全封堵瘘口3例(14%);16例术后出现轻度的胸骨后疼痛不适或胃液反流的症状;1例出现上消化道大出血。22例病人均治愈出院,治愈率100%。结论镍钛记忆合金带膜内支架植入治疗食管癌术后胸内吻合口瘘成功率高,治愈率高,操作简单,安全,见效快,并发症少,有效解除患者痛苦,宜在临床上推广使用。 相似文献
72.
食管癌切除术后不同重建途径吻合口瘘的原因及预防 总被引:18,自引:3,他引:18
目的了解食管癌切除术后经不同径路重建,发生吻合口瘘的情况;探讨系统性淋巴结清扫后,经胸骨后胃代食管颈部吻合口瘘发生率较高的原因及预防方法。方法1105例行食管癌切除术的患者,229例经左胸行胸内吻合(A组),716例经右胸食管床胃代食管行颈部吻合(B组),160例予以系统性淋巴结清扫术后经胸骨后行颈部吻合(C组)。分析比较不同手术径路的3组患者术后吻合口瘘发生的情况。结果吻合口瘘发生率分别为:A组5/229(2.2%)、B组85/716(11.9%)、C组31/160(19.4%),C组吻合口瘘发生率显著高于A、B组(P<0.01和P<0.05)。比较C组不同重建方式吻合口瘘发生率显示,手工吻合与器械吻合(22.2%与11.6%,P=0.133)、全胃重建与管状胃重建(25%与15.6%,P=0.146)间吻合口瘘发生率无明显差异,而延长胃肠减压管留置时间至术后7d,吻合口瘘发生率由23.3%降至9.1%(P<0.05)。结论胸骨后胃代食管吻合口瘘发生率较高的主要原因,是前纵隔内的胃体受压、冲击吻合口所致;通过延长胃肠减压管留置时间能有效减少瘘的发生。 相似文献
73.
Objective To describe our experience of cerebrospinal fluid (CSF) rhinorrhea management.Design Retrospective.Setting Charing Cross Hospital, London, a tertiary referral center.Participants Fifty-four patients with CSF rhinorrhea managed from 2003 to 2011.Main outcome measures Surgical technique; Recurrence.Results Etiologically, 36 were spontaneous and 18 traumatic. Eight patients with spontaneous and two with traumatic leaks had previous failed repairs in other units. Success rates after first and second surgery were 93% and 100%, respectively. Mean follow-up was 21 months. Four patients, all of spontaneous etiology, had recurrences; three of these underwent successful second repair with three layered technique, and the fourth had complete cessation of the leak after gastric bypass surgery and subsequent weight reduction. Adaptation of anatomic three-layered repair since then averted any further failure in the following 7 years. Mean body mass index was 34.0 kg/m2 in spontaneous and 27.8 kg/m2 in traumatic cases (p < 0.05). Fifty percent of spontaneous leaks were from the cribriform plate, 22% sphenoid, 14% ethmoid, and 14% frontal sinus. In the traumatic CSF leak group: 33.3% were from the cribriform plate, 33.3% sphenoid, 22.2% ethmoid, and 11.1% frontal.Conclusion Endoscopic CSF fistula closure is a safe and effective operation. All sites of leak can be accessed endoscopically. We recommend the use of an anatomic three-layered closure in difficult cases. 相似文献
74.
目的探讨食管切除术后胸内吻合口漏的病因、治疗及预防.方法 412例食管切除术中15例发生吻合口漏,9例行非手术治疗,6例行手术治疗.结果行非手术治疗的9例吻合口漏中,7例治愈,2例死亡;行手术治疗的6例中,3例治愈,2例死亡,1例放弃治疗自动出院.结论食管切除术后胸内吻合口漏死亡率高,积极采取防范措施可降低吻合口漏的发生率. 相似文献
75.
A new approach to rectal anastomotic stricture 总被引:2,自引:2,他引:0
Amnon Ovnat M.D. Dr. Jochanan Peiser M.D. Eliezer Avinoah M.D. Ilan Charuzi M.D. 《Diseases of the colon and rectum》1989,32(4):351-353
A technique is presented that can serve as a solution for localized postoperative rectal stricture. This procedure was used
after the failure of manual and instrumental dilatations. It consisted of cutting the prominent plication of the stricture,
using the EEATM stapler. Five patients successfully underwent this operation without morbidity or mortality, three after very low anterior
resection and two after total colectomy, mucosal proctectomy, and ileoanal anastomosis. 相似文献
76.
Background Anastomotic and staple line leaks (ASL) occur after laparoscopic Roux-en-Y gastric bypass (LRYGB) with a reported incidence
as high as 6%. Leaks are the second most common cause of post-LRYGB mortality after pulmonary embolism, and can be associated
with significant morbidity. Prevention and early detection may limit both morbidity and mortality.
Methods A retrospective analysis of prospectively collected data was performed on all LRYGBs performed in a community hospital by
a single surgeon from August 2001 to December 2005. All operations were performed using a linear-stapled anastomosis with
buttressing material, handsewn otomy closures, stay sutures, intraoperative leak testing, and fibrin sealant.
Results 760 patients underwent LRYGB during the study period. Eighty-nine percent (n = 674) were female and 11% (n = 86) were male. Mean body mass index (BMI) was 50 kg/m2 (range 36–83 kg/m2). Mean age was 40 years (range 17–72 years). Two patients developed three gastric pouch staple line leaks (0.4%). There were
no mortalities.
Conclusion Operative technique, including appropriate staple sizing, staple line reinforcement, handsewn otomy closures, placement of
stay sutures, intraoperative leak testing, and placement of fibrin sealant contributed to a lower than expected incidence
of ASL after LRYGB in this series. 相似文献
77.
78.
Two sisters developed spontaneous cerebrospinal fluid (CSF) leaks from meningeal diverticula. Both had recurrences from non diverticular sites. Both patients, a sister, and their mother had joint hypermobility and there was a strong family history of thoracic and abdominal aorta aneurysms. To my knowledge, this is the first report of familial occurrence of CSF leaks. It also points to the role of a pre-existing dural weakness, likely related to a disorder of connective tissue matrix. 相似文献
79.
80.
本文报告1976~1986年收治的食道贲门癌100例的治疗体会。其中男性95例,女性5例,年龄20~79岁,平均52岁。上段食管癌5例,中段59例,下段24例,贲门癌12例。84例作食管、贲门癌切除,食管胃吻合术,切除率为84%;13例因病变不能切除而作食管胃转流术,3例仅作剖胸探查。本组死亡1例,死亡率为1%,好转13例(13%),治愈84例,治愈率为84%。重点讨论了食胃吻合口瘘管和狭窄,以及肺部并发症的预防。 相似文献