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目的总结9例食管癌、贲门癌术后胸内消化道瘘的诊疗经验。方法2001年1月至2006年1月共612例患者行食管癌、贲门癌切除加食管-胃或食管-空肠胸内吻合术,术后9例患者经美蓝试验确诊发生胸内消化道瘘。其中,2例患者急诊行二次剖胸手术治疗,其余7例采用保守治疗。所有患者均进行充分的脓腔、胃液引流,持续的胸腔冲洗,并采用肠内营养保证充足的营养支持。结果胸内消化道瘘患者临床表现无特殊,B超、X线表现为术侧或双侧胸腔积液或液气胸,确诊依赖于口服美蓝试验。胸内消化道瘘发生率为1.47%(9/612),其中吻合口瘘6例(0.98%,6/612),胃壁瘘3例(0.49%,3/612)。9例患者消化道瘘闭合时间9~98d,平均(38.9±5.6)d;住院时间24~196d,平均(79.1±8.2)d;2例二次开胸手术患者术后瘘口愈合时间以及住院时间均低于平均水平。9例患者均临床治愈,无死亡病例。结论食管癌、贲门癌术后胸内消化道瘘一经确诊,在严格掌握手术适应证的前提下,提倡早期行二次开胸手术,同时必须注意充分脓腔引流和适当胸腔冲洗,并进行有效的营养支持,可取得较为满意的临床疗效。
Objective To summarize the experience of diagnosis and treatment of intrathoracic gastrointestinal fistula in 9 cases of esophageal cancer and cardiac cancer. Methods From January 2001 to January 2006 a total of 612 patients underwent esophageal and gastric cardia resection combined with esophageal-gastric or esophageal-jejunal anastomosis. Nine patients were diagnosed with intrabronchial fistula . Among them, 2 patients underwent emergency chest thoracotomy, and the remaining 7 patients received conservative treatment. All patients underwent adequate abscess, gastric drainage, continuous chest irrigation, and enteral nutrition to ensure adequate nutritional support. Results The intrathoracic gastrointestinal fistula patients had no clinical manifestations. The B-ultrasound and X-ray showed pleural effusion or fluid pneumothorax. The diagnosis was dependent on the oral methylene blue test. The incidence of intrathoracic gastrointestinal fistula was 1.47% (9/612), including 6 anastomotic fistulas (0.98%, 6/612) and 3 gastric fistulas (0.49%, 3/612). In 9 patients, the closing time of gastrointestinal fistula was 9-98 days (mean, 38.9 ± 5.6 days); the length of hospitalization was 24- 196 days (mean, 79.1 ± 8.2 days); the time of postoperative fistula healing and hospitalization Time is below average. Nine patients were clinically cured, no deaths. Conclusions After the intrathoracic digestive tract fistula of esophagus and cardia cancer has been diagnosed, under the premise of strict indications of surgical indications, it is recommended to perform secondary thoracotomy in the early stage, meanwhile it must pay attention to full abscess drainage and proper thoracic irrigation and be effective Of nutritional support, can be more satisfied with the clinical efficacy.