食管癌术后胃食管吻合口瘘的诊治体会

目的探讨胃食管吻合口瘘的预防、早期诊断和治疗方法。方法2007年1月至2010年12月，施行食管癌切除＋食管胃胸内吻合术或颈部吻合术278例，术后确诊胃食管吻合口瘘12例。总结患者诊治经过，并对其进行回顾性分析。结果胃食管吻合口瘘的发生率为4．3％（12／278），其中，胸内瘘占3．9％（10／257），颈部吻合口瘘占9．5％（2／21）。保守治疗11例，10例治愈，治愈率为91．0％（10／11），死亡1例，死亡原因为多器官功能衰竭。二次手术1例，最后治愈。结论吻合口瘘是食管重建术后严重的并发症，发生原因复杂，完善术前准备、提高手术操作技巧是预防术后吻合口瘘的关键。早期诊断、有针对性地选择治疗方法能提高吻合口瘘的治愈成功率。

Experience on the diagnosis and treatment of gastroesophageal anastomotic fistula

Objective To investigate the prevention, early diagnosis and treatment of gastroesophageal anastomotic fistula. Methods The clinical data of 278 patients undergoing esophageal resection combined with intra-thoracic esophagogastric anastomosis or cervical anastomosis from January 2007 to December 2010 was retrospectively analyzed. Results Of the 278 patients, 12 cases (4.3%) were diagnosed as gastroesophageal anastomotic fistula postoperatively, including 10 cases (3.9%) of intrathoracic anastomotic fistula and 2 cases (9.5%) of cervical anastomic fistula. Eleven of the 12 patients were under conservative treatment, of which 10 cases were cured (with a cure rate of 91.0%), and one case died with multiple organ failure. One patient received reoperation and was cured successfully.Conclusion Gastroesophageal anastomotic fistula is considered to be one of the most serious complications after esophageal resection and reconstruction. The key to prevent this disease is sufficient preparation before operation and improvement of the surgical techniques. Early diagnose and proper therapy can improve the successful rate of the treatment.