食管癌切除术后胸胃瘘发生的原因和治疗

目的探讨食管癌切除术后胸胃瘘发生的常见原因及治疗措施。方法对我院收治的食管癌切除术后胸胃瘘8例的临床资料进行回顾性分析。结果本组胸胃瘘发生于食管癌切除术后4～5 d 6例,6～11 d 2例;6例瘘口直径<1 cm,行瘘口修补术;2例因胸胃壁大片坏死,先行胸胃大部切除加食管旷置及空肠造瘘术,后分期行结肠代食管术。8例手术均获成功。术后出现声嘶、肺部感染各1例。随访10个月～5年,均可进普通饮食,其中2例饱食后不能平卧,钡餐检查示胸胃淤滞排空不畅,口服促胃动力药物可缓解症状。结论食管癌切除术后远端消化道梗阻是发生胸胃瘘的主要原因,积极手术治疗是保证胸胃瘘预后良好的关键。

Causes and Treatment of Thoracic Gastric Fistula after Transthoracic Esophagectomy

Objective To investigate the common causes and treatment of the thoracic gastric fistulas after transthoracic esophagectomy.Methods The clinical data of 8 cases with thoracic gastric fistula after transthoracic esophagectomy were retrospectively analyzed.Results There were 6 cases of thoracic gastric fistula on day 4-5 postoperatively,and 2 cases on day 6-11 postoperatively.Fistula diameter of 6 cases was less than 1 cm,and the line fistula repair was done;2 cases of large areas of necrosis were managed by subtotal gastrectomy plus the surgery and jejunostomy,after reconstruction of esophagus with colon by stages.8 operations were successful,in which the complication of postoperative hoarseness and pulmonary infection occurred in 1 case respectively.Follow-up lasted from 10 months to 5 years,and all the patients had a normal diet.2 cases of the 8 cases had the symptoms of inability to lie horizontally after satiation,which was alleviated by gastric motility drugs,and barium meal examination showed thoracic gastric stasis and poor emptying.Conclusion The gastric fistula occurs after thoracic esophageal mainly due to distal digestive tract obstruction.Aggressive surgical treatment is the key to ensuring a good prognosis.