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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。
Objective To report the experience of intrathoracic esophagogastric anastomotic fistula after esophageal carcinoma surgery. Methods From 1984 to 1998, a total of 1065 cases of esophageal carcinoma and gastroesophageal manual anastomosis were performed. 28 cases of anastomotic fistula occurred. The incidence was 2.6%. Three cases gave up treatment. Aortic arch anastomosis in 19 cases, bow anastomosis in 6 cases. In the early period, 17 cases were treated conservatively, and in the latter stage 8 cases were reopened. Results In the early period, 17 cases were treated conservatively, and 12 cases died. The mortality rate was 70.6%. In the later period, 8 cases were re-opened and 1 died. The mortality rate was reduced to 12.5%. There are significant clinical differences between the two treatments. Conclusion Chest X-ray examination, oral methylene blue, and esophageal radiography are the main methods for the early diagnosis of anastomotic leakage. As long as the patient’s systemic and local conditions permit, re-opening thoracic surgery is the key to successful treatment.