胸内食管胃吻合口瘘25例临床分析

目的 报告食管癌贲门癌根治术后发生胸内食管胃吻合口瘘治疗经验。方法 1984～1998年,共施行食管癌贲门癌根治术,胸内食管胃手工吻合术1065例,发生吻合口瘘28例,发生率2.6%,3例放弃治疗。主动脉弓上吻合19例,弓下吻合6例。前期17例采用保守治疗,后期8例再次开胸手术。结果 前期17例采用保守治疗,死亡12例,死亡率70.6％;后期8例采用再次开胸手术,死亡1例,死亡率降为12.5％。两种治疗方法临床差别显著。结论 胸部X线检查,口服美兰,食管造影是早期诊断吻合口瘘的主要手段,只要患者全身和局部情况允许,再次开胸手术是治疗成功的关键。

Clinical research of thoracic anastomotic leakage of esophagogastrostomy( With 25 Cases Reported)

Objective To evaluate surgical treatment experience for the patients with thoracic anastomotic leakage of esophagogastrostomy. Methods From 1984 to 1988, thoracic esophagogastrostomy was performed in 1065 cases of esophageal carcinoma and gastric cardiac carcinoma, all of them underwent left thoracic operation. there were 28(2.6% ) anastomotic leaks,of which 17 patients received non surgical treatment, while 8 patients were trated surgically again,but 3 rejected any therapy.among 25 patients, 19 were Super-Aortic arch anastomosis and 6 were Lower Aortic arch anastomosis .Results The morally rate was 70.6% (12/17)in the patients with non surgical treatment,the other was 12.5% (1.8)in the patients with reop-eration. there was significantly diference between two groups. Conelusion Accurate diagnosi of thoracic anastomotic leakage depends mainly on the chest X - ray examination, radiograohy of the esofagus and oral adminstration of methylene blue solution, as long as general and local conditions permit , reoperation played an important role in the therapy of anastomtic leakage.