食管贲门癌术后吻合口瘘性脓胸的防治探讨

目的探讨食管贲门癌术后吻合口瘘性脓胸发生的原因、诊断方法及防治措施. 方法对1972～2003年间手术切除的食管贲门癌4 890例中发生吻合口瘘性脓胸的42例临床资料进行回顾性分析. 结果全部行胸腔闭式引流,12例放置上、下胸管,采用30%乙醇胸腔灌洗加负压吸引治疗,痊愈;25例再次手术,其中2例颈部带血管蒂肌瓣填塞瘘口治愈,23例瘘口缝合后用医用生物蛋白胶或大网膜填塞、仅4例死亡;5例因中毒性休克、衰竭,不能再次手术而死亡. 结论严格选择病例、充分做好术前准备、注意手术操作、改进吻合方法、加强术后处理是预防吻合口瘘性脓胸的关键.

Pyothorax due to Postoperative Anastomotic Leakage in Esophageal and Cardiac Cancer Surgery: Prevention and Treatment

OBJECTIVE To investigate the causes of disease and the measures of diagnosis, prevention and treatment for pyothorax due to postoperative anastomotic leakage in esophageal and cardiac cancer surgery. METHODS The data of 42 cases of pyothorax due to postoperative anastomotic leakage in esophageal and cardiac cancer patients were analyzed retrospectively. RESULTS All cases were treated with thoracentesis. Twenty five cases were operated again,only 4 cases of them died. After that five cases died of toxic shock and exhaustion. Others had perfectly recovered from their illness. CONCLUSIONS To take more perioperative measures is the key to prevent pyothorax due to anastomotic leakage.