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目的分析食管癌术后胸内吻合口瘘治疗方法的合理选择。方法食管癌术后胸内吻合口瘘患者18例中,食管癌术后3d内发生吻合口瘘4例,给予急诊手术治疗,瘘口修补术1例,左颈部吻合口重建3例;食管癌术后5~16d发生吻合口瘘14例,行非手术治疗,在数字减影血管造影下置入鼻胃管2根,1根插入空肠内行肠内营养,另1根经吻合口瘘口插入瘘口外脓腔,以甲硝唑反复冲洗脓腔,然后持续负压引流脓腔;12例有液气胸者同时行胸腔闭式引流,3d后胸管内无引流液,摄片示肺膨胀好,拔除胸管。结果 18例患者全部治愈,无死亡病例。结论食管癌术后胸内吻合口瘘早期诊断,采取手术及非手术治疗等有效治疗措施可改善患者预后。
Objective To analyze the reasonable choice of thoracic anastomotic fistula after esophagectomy. Methods Among the 18 cases of esophageal anastomotic leakage after esophagectomy, 4 cases of esophageal cancer developed anastomotic fistula within 3 days after operation, giving emergency surgery, 1 case of fistula repair and 3 cases of left anterior cervical anastomosis reconstruction. Fourteen cases of anastomotic fistula occurred from 5 to 16 days after operation, and underwent non-surgical treatment. Two nasogastric tubes were placed under digital subtraction angiography. One was inserted into jejunum for enteral nutrition and the other was anastomotic fistula Insert fistula outside the abscess, with metronidazole repeatedly rinse abscess, and then continue to negative pressure drainage abscess; 12 patients with liquid pneumothorax at the same time closed thoracic drainage, 3d after no drainage tube chest tube, the film shows good pulmonary expansion , Remove the chest tube. Results 18 patients were completely cured, no deaths. Conclusion The early diagnosis of esophageal anastomotic leakage after esophageal cancer surgery and non-surgical treatment and other effective measures to improve the prognosis of patients.