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目的总结胃癌切除术后食管胃或食管空肠吻合口漏的营养支持经验,以提高对食管胃或食管空肠吻合口漏的治疗水平。方法对1997年1月至2006年12月,中国人民解放军总医院治疗的胃癌切除术后6例食管胃吻合口漏和13例食管空肠吻合口漏共19例病人进行回顾性分析。结果19例均加强吻合口附近的腹腔引流,采用持续胃肠减压,均先给予肠外营养支持、然后从肠外营养支持逐步过渡到肠内营养支持的治疗手段。16例在肠外营养液中强化了谷氨酰胺,19例均使用生长抑素,5例在吻合口漏愈合期加用了生长激素。在首次胃癌切除术后,4例漏口21~30d自愈,12例漏口30~60d愈合,2例漏口60~81d愈合,1例因严重的左侧胸腔、肺部感染合并腹腔感染于首次胃癌切除术后42d死亡。结论保证腹腔引流的通畅、持续胃肠减压,特别是肠外结合肠内营养支持、强化谷氨酰胺、生长抑素、生长激素等措施,是促进胃癌切除术后食管胃或食管空肠吻合口漏愈合的重要手段。
Objective To summarize the nutritional support experience of esophageal or esophageal anastomotic leakage after gastric resection in order to improve the treatment of esophageal or esophageal anastomotic leakage. Methods From January 1997 to December 2006, 6 cases of esophagogastrostomy and 13 cases of esophageal anastomotic leakage after gastric cancer resection were treated by Chinese PLA General Hospital. A total of 19 patients were retrospectively analyzed. Results All of the 19 patients underwent peritoneal drainage near the anastomotic site. All patients underwent continuous gastrointestinal decompression. All patients underwent parenteral nutrition support and then gradually transition from parenteral nutrition support to enteral nutrition support. 16 cases of glutamine in parenteral nutrition fortified, 19 cases were used somatostatin, 5 cases of anastomotic leakage in the combined use of growth hormone. After the first resection of gastric cancer, 4 cases recovered from 21 to 30 days, and 12 cases recovered from 30 to 60 days. 2 cases had anastomotic leakage from 60 to 81 days and 1 case suffered from severe infection of the left chest and lung with abdominal infection Died 42 days after the first gastric cancer resection. Conclusion To ensure peritoneal drainage of patency, continuous gastrointestinal decompression, especially parenteral enteral nutrition support, to strengthen the glutamine, somatostatin, growth hormone and other measures to promote gastric resection esophageal or esophageal jejunostomy Leakage healing an important means.