食管胃胸腔内吻合口瘘的临床诊治研究

目的探讨食管胃胸腔内吻合口漏的预防及治疗。方法选择2002年7月至2011年7月青岛市第八人民医院诊治的食管癌患者中实施胸腔内吻合术的患者126例,其中9例发生胸腔内吻合口漏,根据患者不同临床表现、X线胸片、B超及胸部CT结果选择并改进治疗方法,并对治疗结果进行回顾性分析。结果 6例患者再次手术,采用改良的三管治疗,治愈率为100%。3例患者经保守治疗,其中2例治愈,1例死亡。结论一旦发生吻合口瘘,采取恰当措施能有效地减少患者的病死率,B超和CT结合使用有助于诊断和指导治疗,采用改良三管治疗,能提高吻合口瘘的治愈率。

Diagnosis and Treatment of Anastomotic Leakage in Thorax after Esophagectomy

Objective To evaluate the prevention and treatment of anastomotic leakage in thorax after esophagectomy.Methods A retrospective analysis of clinical data was conducted in 9 esophageal cancer patients with postoperative anastomotic leakage out of 126 cases undergoing intrathoracic anastomosis admitted to Qingdao Eighth People′s Hospital from July 2002 to July 2011.Different treatments were chosen and improved according to individual clinic findings and results of chest X-ray,CT,B-ultrasound.Reoperation was performed and the outcome of treatment was retrospectively reviewed.Results 6 patients with second surgery were treated by improved three tubes drainage,the cure rate was 100%.3 patients were given conservative surgery,2 were cured and 1 died.Conclusion Appropriate treatments can improve the outcome for the patients with anastomotic leakage in thorax after esophagectomy.A combined use of B-ultrasound and CT is beneficial to the diagnosis and treatment.The use of improved three tubes drainage treatment can promote the cure rate of the anastomotic leakage.