23例食管癌术后胸内吻合口瘘的处理体会

目的探讨食管癌术后并发胸内吻合口瘘的治疗方法。方法23例吻合VI瘘患者行充分引流、控制脓胸、防治呼吸衰竭、营养支持等保守治疗，肠内营养。1例行二次开胸手术清理脓腔及置管引流；2例放置带膜钛一-镍记忆合金食管支架。结果治愈19例，院内死亡2例，其中1例死于死因均为感染未控制导致呼吸衰竭、中毒性休克，1例死于胸腔内大出血。自动出院2例。结论及时选择适当的治疗方法能提高胸内吻合口瘘的治愈率，降低死亡率，合理的二次开胸清创置管引流以及食管带膜支架置人的方法值得推荐。

Treatment of intrathoracic anastomotic leakage following surgery for esophageal cancer for 23 patients

Objective To explore the treatment of anastomotic leakage after surgical operation for esophageal cancer and cardia cancer. Methods Twenty-one of them received full chest drainage, empyema control, treatment for respiratory failure, nutritional support and other conservative therapies ; 1 of them underwent a second thoracotomy and catheter drainage for abscess cleaning, and 1 of them was placed titaniumnickel-memory alloy covered esophageal stent. Results Nineteen cases were cured. Two died during hospitalization. The cause of 1 death was respiratory failure and toxic shock due to uncontrolled infection and the other died of bleeding in the chest. Two ca ses were self-discharged. Conclusions Properly selected procedures can improve the clinical effectiveness on intrathoracic anastomotie leakage and mortality can be reduced. The procedure of secondary thoracotomy tube drainage and esophageal stent placement is worth to recommend.