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目的:探讨胃镜引导下置入十二指肠营养管治疗食管癌术后并发吻合口瘘的临床效果及其应用体会。方法:在2008年1月至2011年9月入我科治疗的3126例食管癌手术患者中,49例术后并发吻合口瘘,患者经胃镜引导下置营养管于十二指肠降部,给予肠内营养治疗。术前1天、术后第5天、第7天、出院时分别测定患者体重,术后第1天起逐日观察患者肛门排气、排便等胃肠功能恢复情况。结果:49例患者中首次置管成功47例,成功率96%,置管时间10～20min,平均12min,置管及术后未发生严重并发症;鼻肠营养管肠内营养术后第7天体重下降≤2kg;肠道功能恢复快,术后肛门排气时间≤3d。结论:置入营养管的长度要较胃镜观察长约20cm并妥善固定可提高首次置管成功率。胃镜引导下置入十二指肠营养管对食管癌术后并发吻合口瘘的患者是一种安全、方便、有效的肠内营养途径,对此类患者的营养治疗起重要支持作用,具有临床应用价值。
Objective: To investigate the clinical effect and application of gastroscope guided duodenal feeding tube in the treatment of esophageal cancer after anastomotic leakage. Methods: From January 2008 to September 2011, 3126 patients undergoing esophageal cancer surgery were treated with anastomotic fistula. Forty-nine patients underwent endoscopic anastomotic fistula with gastroscope, and placed under the descending part of the duodenum. Give enteral nutrition treatment. One day before surgery, the 5th day and the 7th day after operation, the body weight of the patients was determined at discharge and the recovery of gastrointestinal function such as anal exhaust and defecation was observed day by day on the first postoperative day. Results: Of the 49 patients, 47 cases were successfully treated for the first time, the success rate was 96%, the duration of catheterization was 10 to 20 minutes, an average of 12 minutes. There were no serious complications after catheterization and postoperatively. Body weight loss ≤ 2kg; intestinal function recovered quickly, anal exhaust time ≤ 3d. Conclusion: The length of the feeding tube should be 20cm longer than gastroscope observation and properly fixed to improve the success rate of the first tube insertion. Endoscopic duodenal feeding catheter placed under the guidance of esophageal cancer patients with anastomotic leakage after fistula is a safe, convenient and effective route of enteral nutrition, nutrition support for these patients play an important role, with clinical Value.