食管癌术后颈部吻合口瘘的诊治

目的：对食管癌患者术后颈部吻合口瘘的诊断及治疗体会进行分析，为降低食管癌患者的病死率提供有益的参考。方法该院2010年1月-2013年1月收治食管癌患者186例，其中有37例发生颈部吻合口瘘，根据患者吻合口瘘发生部位、大小、发生时间以及患者身体状况采取保守治疗。结果患者在术后30～40 d开始流质饮食，经观察引流管未有食物析出。1例食管气管瘘患者行瘘口修补及瘘管切除术治疗。患者在5～8周内均形成窦道吻合，未有患者发生肺部感染或死亡，治疗前后患者生活质量比较情况：在吞咽困难（t=-3.527，P=0.001），进食（t=-3.399，P=0.002），疼痛（t=-5.942，P=0.000），梗阻（t=-3.091，P=0.004）维度当面差异有统计学意义（P＜0.05），在反流（t=-0.199，P=0.843），咽口水（t=-0.097，P=0.923），食欲减退（t=0.205，P=0.838）方面差异无统计学意义P＞0.05）。结论早期明确患者病情，并进行充分引流、营养支持、抗感染治疗及手术治疗的情况下，可以降低吻合口瘘患者的病死率，提高患者的生活质量。

Diagnosis and Treatment of Cervical Anastomotic Fistula after the Opera-tion of Esophageal Carcinoma

Objective To analyze the diagnosis and treatment of patients with cervical anastomotic fistula after the operation of esophageal carcinoma so as to provide a useful reference for reducing the mortality rate of esophageal carcinoma patients. Meth-ods 186 cases of patients with esophageal carcinoma were admitted into our hospital from January, 2010 to January, 2013, of whom, 37 cases had cervical anastomotic fistula and they were given expectant treatment according to the site, size, time of occur-rence of anastomotic fistula, and the physical conditions of the patients. Results The patients first had liquid diet 30-40d after the operation, and there were no food in the drainage tube. 1 case of esophago-tracheal fistula had fistula repair and fistula resection treatment. Sinus anastomosis was formed in the 5 to 8 week, and no patients had pulmonary infection or died. Compare the quality of life of patients before and after treatment：difficulty in swallowing （t=-3.527, P=0.001）, eating （t=-3.399, P=0.002）, pain （t=-5.942, P=0.000）, obstruction （t=-3.091, P=0.004） were statistically significant differences between face to face dimensions （P〈0.05）, at the aspects of reflux （t=-0.199, P= 0.843）, swallowing （t=-0.097, P=0.923）, loss of appetite （t=0.205, P=0.838）, the dif-ferences were not statistically significant （P〉0.05）. Conclusion The mortality rate of cervical anastomotic fistula could be dropped down and the life quality of the patients can be improved by early diagnosis of the patients＇ condition, adequate drainage, nutri-tional support, anti infection treatment and operation treatment.