食管癌术后颈部吻合口瘘引发脓胸的临床特点与处理对策

目的 探讨食管胃颈部吻合术后颈部吻合口瘘导致脓胸的发生特点及处理对策.方法 对2006年1月至2013年1月间河南省安阳肿瘤医院胸外科施行食管癌切除颈部吻合术患者的临床资料进行回顾性分析.结果 全组共计3342例食管癌患者行食管胃颈部吻合术,其中左颈左胸二切口2248例（左颈左胸术组）,右胸三切口1094例（右胸术组）.术后共计发生颈部吻合口瘘237例（7.1％,237/3342）,左颈左胸术组152例（6.8％）,右胸术组85例（7.8％）,差异无统计学意义 （P=0.287）.19例患者引致脓胸（8.0％,19/237）,左颈左胸术组3例（2.0％）,右胸术组16例（18.8％）,差异有统计学意义 （P＜0.01）.脓胸发生在3d以内者14例（73.7％,14/19）.19例脓胸患者均采用保守治疗,包括行胸腔闭式引流,经鼻腔放置十二指肠营养管或通过空肠造瘘管予以肠内营养支持治疗,并辅以肠外营养支持及抗炎对症治疗.最终治愈16例,死亡3例.结论 右侧开胸手术后发生颈部吻合口瘘易导致脓胸.充分引流及良好的营养支持是治疗的重点.

Clinical features and management of pyothorax due to postoperative cervical anastomotic leakage in esophageal cancer surgery

Objective To investigate the clinical characteristics and managements of pyothorax due to postoperative cervical anastomotic leakage after esophageal cancer surgery.Methods From January 2006 to January 2013,3342 patients with esophageal carcinoma underwent esophagectomy and cervical esophagogastric anastomosis.Of them,19 patients developed pyothorax following cervical anastomotic leakage and their clinicopathological data were analyzed retrospectively.Results All the patients underwent a cervical anastomosis via a three-incisional approach （right cervicothoracic midabdominal incision,RT group,n=1094） or a two-incisional approach （left cervicothoracic incision,LT group,n=2248）.The total number of cervical anastomotic leakage cases was 237,of which 152 cases were in LT group（6.8%）,and 85 cases in RT group（7.8%）,respectively（P=0.287）.The incidence of pyothorax was 2.0%（n=3） in LT group,and 18.8%（n=16） in RT group,respectively （P〈0.01）.Fourteen cases develop pyothorax within 3 days after operation.The main symptoms were high fever,dyspnea and chest pain.All the pyothorax patients received conservative treatments,including thoroacic closed drainage,nasogastric tube placement,jejunal stoma,nutritional support,antibiotics and symptomatic treatment.Sixteen cases were cured,while 3 cases were dead.Conclusions The right thoracotomy approach predisposes the cervical anastomotic leakage-associated pyothorax.Sufficient drainage and sufficient nutritional support are critical to the treatment.