摘要
目的探讨食管、贲门癌术后消化道瘘及相关并发症的临床分型及有效处理方法。方法回顾性分析我院胸外科2010年1月至2012年12月行食管、贲门癌根治术421例中术后消化道瘘42例及同期外院转入胸内消化道瘘11例，总结此53例消化道瘘及其相关并发症的临床表现和治疗经验。结果再手术10例，均治愈。管状胃切缘瘘致纵隔感染败血症死亡2例，呼吸衰竭、营养不良致多器官功能衰竭、左、右支气管瘘各1例死亡，病死率11．90％（5／42）。结论消化道瘘临床分为I败血症型、Ⅱ呼吸衰竭型、Ⅲ胸腔感染型、Ⅳ颈部切口感染型。胸内吻合口瘘争取24h内再手术是修补成功的关键；胸腔多发包裹性积液导致的呼吸衰竭，支气管瘘也是再手术适应证。肺的完全复张，消灭胸腔残腔和充分的引流是治疗的关键。电视胸腔镜引导下放置引流管，是解决胸腔引流不畅的微创方法；合并切口感染并与脓胸腔相通，可通过清创、肌层充分游离、分层缝合隔离切口和感染的胸膜腔，使胸内瘘口感染和感染切口分开，同时，在电视胸腔镜引导下于瘘口下放置引流管从另一部位正常皮肤引流出，行胸腔引流，胸内瘘口感染和感染切口分开愈合。
Objective Discuss clinical type and treatment of postoperative digestive tract fistula and associate complica- tions of esophageal or cardiac cancer. Methods Analized clinical manifestations and treatment retrospectively of 53 cases of digestive tract fistula after operation of esophageal or cardiac cancer from January, 2010 to December, 2012. Results All the 10 undergoing surgery are cured by reoperation. 2 died of mediastinal infection and sepsis. 4 died of respiratory failier ,malnu-trition,left and fight bronchal fistula, respectively. Conclusion There are 4 types of fistula： I type of sepsis, Ⅱ type of re- spiratory failure, Ⅲ type of thoracic infection, Ⅳ type of neck inection. Reoperation within 24 hours is the key of suscessful repairment of intrathoracic anastmotic leakage. Bronchal fistula or respiratory failure caused by multiple thoracic encapsulated effusion is also the indication of surgery. Complete lung reexpansion and complete drainage is the key. Mini-invasive VATS is the method of exact drainage.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2014年第1期11-13,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
食管肿瘤
贲门
消化系统瘘
手术后并发症
Esophageal neoplasms
Cardiac
Digestive system fistula
Postoperative complication
