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目的:探讨食管癌、贲门癌切除术后发生吻合口瘘的原因及吻合口瘘的诊断和治疗方法。方法:对1452例食管癌、贲门癌切除术的临床资料进行回顾性分析。1452例术后发生吻合口瘘37例,颈部吻合口瘘16例均行保守治疗,胸部吻合口瘘21例,保守治疗17例,再次开胸手术治疗4例。结果:37例吻合口瘘治愈30例,死亡7例(23.33%),颈部瘘16例全部治愈。胸内瘘21例保守治疗17例,治愈12例(70.59%),死亡5例(29.41%),2例二次瘘口修补,治愈1例(50.00%),死亡1例(50.00%),2例二次吻合口切除再吻合,治愈1例(50.00%),死亡1例(50.00%)。结论:手术操作技术和肿瘤大小、部位及吻合口张力是影响吻合口愈合的重要的因素,应及时诊断和处理吻合口瘘,根据病情尽早争取再次手术或保守治疗是治疗成功的关键。
Objective: To investigate the causes of anastomotic fistula after esophageal and cardiac resections and the diagnosis and treatment of anastomotic fistula. Methods: The clinical data of 1452 cases of esophageal cancer and cardiac cancer resection were analyzed retrospectively. Among the 1452 cases, 37 cases were anastomotic fistula, 16 cases were anastomotic fistula, 21 cases were anastomotic fistula, 17 cases were conservative treatment and 4 cases were treated by thoracotomy again. Results: Thirty-seven cases of anastomotic fistula were cured, 7 died (23.33%) and 16 cases of neck fistula were cured. Thoracic fistula was treated conservatively in 21 cases, cured in 12 cases (70.59%), died in 5 cases (29.41%), repaired in 2 cases with secondary fistula, cured in 1 case (50.00%) and died in 1 case (50.00% One case (50.00%) was cured and one case died (50.00%) after two anastomotic resections and anastomoses. Conclusion: Surgical operation technique, tumor size, site and anastomotic tension are important factors that affect the healing of anastomotic stoma. Diagnosis and treatment of anastomotic fistula should be promptly diagnosed. Re-operation or conservative treatment as soon as possible is the key to successful treatment.