食管癌切除术后胸胃瘘18例的保守治疗

目的 评价食管癌切除术后胸胃瘘保守治疗的可行性。方法 18例胸胃瘘患者均给予保守治疗。禁食，瘘口附近重置胸腔闭式引流管，必要时可在透视下定位管口位置，瘘口较大时甚至可以直接将管口放入瘘口内，负压吸引及时引流胃液。如果胃管未拔则持续胃肠减压；如果置有营养管则继续保留；如果没有则在胃镜牵引下置入营养管到十二指肠降部，肠内外营养同时进行，每日管喂量1000～2000ml。加强抗感染并应用H2受体拮抗剂和质子泵抑制剂。结果15例瘘口愈合出院，2例死亡，1例自动出院不久死亡。治愈率83.3％(15／18)，病死率16．7％(3／18)。结论 食管癌切除术后胸胃瘘的保守治疗较积极的二次开胸手术疗效明显，病死率明显降低，是一种值得推广应用的方法。

The expectant treatment to gastric fistula after esophagectomy

Objective To evaluate the expectant treatment to gastric fistula after esophagectomy.Methods All of 18 cases of gastric fistula were accepted the expectant treatment.Absolute diet,thoracic close drainage tube was put nearby orificium fistulae,the position of tube was identified in perspective,the tube was put into the bigger orificium fistulae.Gastric fluid were drained through vacuum aspiration in time.Continue gastrointestinal decompression as a gastric tube were not pulled out.Remaining nutrient canal,or nutrient canal was put into descendant duodenum through gastroscope.Enteral nutrition and parenteral alimentution carried out at the same time,latter were 1000-2000ml,to strengthen anti-infection.H 2 receptor antagonist and proton pump inhibitor were used.Results 15 cases orificium fistulae accreted and recovery,2 cases died,1 case died after discharge shortly.Cure rate 83.3%(15/18).Death rate 16.7%(3/18).Conclusion The expectant treatment to gastric fistula after esophagectomy were better than exploratory thoracotomy.Death rate cut down obviously,the method was worth of spreading.