食管癌切除术后食管胃吻合口瘘原因分析

本文对九例食管癌切除手术后发生食管胃吻合口瘘的患者着重分析瘘发生的原因,其中有胃、十二指肠梗阻、术后早期并发肺部严重感染,因操作不当误伤食管壁肌层及被胃管压迫致食管侧后壁坏死而发生瘘各一例;过早进食粗糙食物二例;因使用“气箱式胃肠减压器”不当造成向胃内充气致瘘二例。本组9例中8例为胸内瘘,1例为颈瘘。在8例胸内瘘中其吻合口位于主动脉弓上者6例,位于主动脉弓下者2例。结合本组发生瘘的原因,对吻合口的张力及吻合口周围缺乏组织保护与瘘发生的关系进行分析讨论。

Causes of Esophagogastric Fistula After Resection of Esophageal Carcinoma

This paper analyzed the causes of leakage at the site of anastomosis after esophagogastrostomy of 9 cases. Gastric obstruction, duodenal obstruction, early infection of lung, damage to the muscle layer during mobilizing esophagus and the compression of the posterior wall of esophagus by the gastric tube were considered the causes in 5 cases, Other 2 cases were caused by early feeding of coarse food injudiciously without medical order and the last 2 cases caused by the disuse of air suction apparatus resulting in huge air of positiveamount pressure inflating the gastric cavity rapturing the anastomomsis promptly. 8 cases of this group arc intrathoracic leakage and 1 case is cervical. In the cases of intrathoracice leakage, 6 cases are supra-arch and 2 are infra-arch. Corelating with the cases of leakage, tension of anastomosis, lack of tissue protection around the anastomosis, the relationship of occurrence of leakage was anaslysed and discussed.