37例食管癌和贲门癌切除术后吻合口瘘临床分析

目的：探讨食管癌、贲门癌切除术后发生吻合口瘘的原因及吻合口瘘的诊断和治疗方法。方法：对1452例食管癌、贲门癌切除术的临床资料进行回顾性分析。1452例术后发生吻合口瘘37例，颈部吻合口瘘16例均行保守治疗，胸部吻合口瘘21例。保守治疗17例。再次开胸手术治疗4例。结果：37例吻合口瘘治愈30例，死亡7例（23．33％），颈部瘘16例全部治愈。胸内瘘21例保守治疗17例，治愈12例（70．59％）。死亡5例（29．41％），2例二次瘘口修补，治愈1例（50．00％），死亡1例（50．00％）。2例二次吻合口切除再吻合，治愈1例（50．00％），死亡1例（50．00％）。结论：手术操作技术和肿瘤大小、部位及吻合口张力是影响吻合口愈合的重要的因素，应及时诊断和处理吻合口瘘，根据病情尽早争取再次手术或保守治疗是治疗成功的关键。

Clinical analysis of 37 cases anastomotic fistula after resection of carcinoma of esophagus and cardia

Objective: To investigate the cause, diagnosis and treatment of the anastomotic fistula after esophageal cancer and cardia cancer resection. Methods: Clinical data of 1 452 patients were analysed retrospectively . These patients were resected of carcinoma of esophageal and cardia from January 1985 to October 2004. Results: Anastomotic fistula were found in 37 cases out of 1 452, 30 cases were cured and 7 died (23. 33%). Among the total cervical fistula were 16 cases. All of them were cured. Internal of thoracic fistula were 21 cases, 17 cases accepted expectant treatment, 12 cases were cured(70. 59%) and 7 died (29.41%), 2 cases were reoprated to repair orificium fistulae, 1 case was cured(50. 00%) and 1 died (50. 00%), 2 cases were reoprated to resect stoma reanastomosis, 1 cases was cured(50. 00%) and 1 died (50. 00%). Conclusion: Procerdure technique, lesion location, amplitude and situation of anastomotic stoma are predominant perfect anastomotic heal reason. Early diagnosis and treatment are keys of succeeded treatment.