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目的比较两种不同食管癌、贲门癌切除术后胸内吻合口瘘治疗方法的疗效。方法回顾分析1999年6月至2008年6月间中国医学科学院肿瘤医院胸外科连续4515例食管癌、贲门癌切除、食管胃胸内吻合术后发生吻合瘘的71例患者的临床资料,并将再次全麻下开胸置引流的38例作为手术治疗组,而另外33例经局麻置引流的作为保守治疗组,比较和讨论两组的治疗结果。统计方法采用SPSS 13.0软件包中的χ2检验和t检验。结果手术治疗组治愈率为86.8%,保守治疗组治愈率为75.6%(P=0.228)。手术治疗组痊愈者平均住院时间52.7 d,保守治疗组为73.7 d(P=0.041)。手术治疗组痊愈患者的平均住院费用为11.6万元,保守治疗组为14.7万元(P=0.045)。结论食管癌、贲门癌切除术后胸内食管胃胸内吻合口瘘一旦确诊或高度怀疑后,尤其对于病情危重的早期瘘,应尽快再次开胸充分引流。
Objective To compare the curative effects of thoracic anastomotic fistula after resection of two kinds of esophageal cancer and gastric cardia cancer. Methods From June 1999 to June 2008, the clinical data of 45 consecutive patients with esophageal and gastric cardia resections and 71 anastomotic fistulas after esophagogastrostomy in the Department of Thoracic Surgery, Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. Under general anesthesia, thoracotomy drainage of 38 cases as a surgical treatment group, while the other 33 cases of local anesthesia drainage as a conservative treatment group, compared and discussed the treatment of the two groups. Statistical methods using SPSS 13.0 software package χ2 test and t test. Results The cure rate was 86.8% in surgical treatment group and 75.6% in conservative treatment group (P = 0.228). The average length of hospital stay in patients who underwent surgery was 52.7 days and that in the conservative group was 73.7 days (P = 0.041). The average cost of hospitalization for cured patients was 116,000 yuan in the surgical treatment group and 147,000 yuan in the conservative treatment group (P = 0.045). Conclusions After esophageal and cardiac resections of thoracic esophageal and gastric anastomotic fistula, once diagnosed or highly suspected, especially for the early stage of critical fistula, full chest drainage should be done again.