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目的调查食管癌颈部吻合术后并发吻合口瘘的发病及预后情况,总结其处理方法、原则。方法分析同一术者于2013年1月—2014年12月连续进行的403例接受颈部机械吻合的食管癌患者,统计、分析吻合口瘘的发生及处理。结果所有患者均成功治愈,单纯颈部瘘患者均应用切口内负压引流方法治疗,7例(63%)患者均于2周内痊愈,平均治愈时间为18.2 d。纵隔瘘患者均经颈部切口或胃镜下放置负压引流管至纵隔瘘腔内持续负压吸引,平均治愈时间为46.5 d。73%的吻合口瘘出现在术后7 d以后,出现胃壁坏死的为12例,约占80%。12例是通过颈部触诊发现,3例在X线透视下发现。7例患者未放置胃肠减压,且均于3周内愈合。吻合口瘘患者发生吻合口狭窄比率为30%,发生率远高于未发生吻合口瘘患者的4%(P<0.05)。结论食管癌颈部吻合方式安全可靠,但过分包埋反而会增加瘘的几率;颈部触诊是发现瘘简单、准确的方法;负压引流方法治疗吻合口瘘安全、有效。
Objective To investigate the incidence and prognosis of esophageal fistula after anastomosis of esophageal neck and to summarize the treatment methods and principles. Methods 403 consecutive esophageal cancer patients undergoing mechanical neck anastomosis between January 2013 and December 2014 were analyzed and the incidence and treatment of anastomotic fistula were analyzed statistically. Results All the patients were successfully cured. The patients with pure neck fistula were treated with negative pressure drainage in the incision. Seven patients (63%) recovered within 2 weeks with an average cure time of 18.2 days. Patients with mediastinal fistula were placed under the neck incision or endoscopy negative suction drainage tube to the mediastinal fistula cavity continued negative pressure, the average healing time was 46.5 d. 73% of anastomotic fistula occurred after 7 days after operation, gastric wall necrosis occurred in 12 cases, accounting for about 80%. 12 cases were found by palpation of the neck and 3 cases were found by X-ray. Seven patients did not place gastrointestinal decompression, and were healed within 3 weeks. The rate of anastomotic stenosis in patients with anastomotic fistula was 30%, which was much higher than that in patients without anastomotic leakage (P <0.05). Conclusion The anastomosis of esophageal neck is safe and reliable, but over-embedding may increase the risk of fistula. Palpation of the neck is a simple and accurate method for detecting fistula. It is safe and effective to treat anastomotic fistula with negative pressure drainage.