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食管癌和贲门癌切除术后发生吻合口瘘是一严重并发症,以往死亡率在50%以上。因此探讨其发生原因,重视预防和治疗措施是提高手术疗效的重要环节。我院胸外科自1961年1月至1979年11月行食管癌和贲门癌切除、食管胃吻合术337例,发生吻合口瘘18例,发生率5.3%。由于采取了一些预防措施,1975年1月以后切除的160例中,瘘4例,发生率2.5%。1977年10月到1979年11月切除75例未发生瘘。现作初步分析如下:瘘发生的时间本组18例吻合口瘘,发生在术后一周以内者5例,8—10天者8例,10天以上者5例,其中最晚的1例发生在术后第17天。瘘与肿瘤部位及吻合口高低的关系337例中,颈部吻合37例,发生瘘3例,占8.1%。弓上吻合94例,发生瘘6例,占6.4%。弓下吻合206例,瘘9例,占4.3%。
The occurrence of anastomotic leakage after resection of esophageal and cardiac cancers is a serious complication. The previous death rate was above 50%. Therefore, the reason for its occurrence and the emphasis on prevention and treatment are important steps in improving the efficacy of surgery. In our hospital from January 1961 to November 1979, 337 cases of esophagogastric anastomosis and esophagogastric anastomosis were performed, and 18 cases of anastomotic fistula occurred. The incidence rate was 5.3%. Due to some precautionary measures taken, 160 cases were removed after January 1975, and 4 cases were paralyzed. The incidence rate was 2.5%. From October 1977 to November 1979, 75 cases had no hernia. The preliminary analysis is as follows: The time of occurrence of fistula is 18 cases of anastomotic leakage in this group, which occurred in 5 cases within one week after operation, 8 cases in 8 to 10 days, and 5 cases in 10 days or more. The latest case occurred in 1 case. On the 17th day after surgery. Among the 337 cases of the relationship between the hernia and the tumor site and the anastomosis level, 37 cases were neck anastomosis and 3 cases occurred hernia, accounting for 8.1%. There were 94 cases of anastomosis on the arches, and 6 cases occurred, accounting for 6.4%. There were 206 cases of anastomosis under the arch and 9 cases of sputum, accounting for 4.3%.