【摘要】 目的 内镜下诊治食管、贲门癌术后吻合口瘘的效果分析。方法 2010年1月至2014年6月内镜下诊治食管、贲门癌术后吻合口瘘患者155例(A组),与未经内镜治疗的98例患者(B组)作对照比较。结果 两组患者皆顺利完成内镜下诊断和(或)治疗,术后平均恢复进食天数:A组为(6.5±3.7)d,较B组(14.8±8.1)d明显缩短;术后平均住院天数:A组为(7.8±4.0)d,较B组(18.4±9.3)d明显缩短;住院平均费用:A组为(5.6358±0.923)万元,较B组(12.936±3.854)万元明显减少,A、B两组比较差异有统计学意义(P<0.05)。两组患者随访12个月,A组无并发症死亡、吻合口复发病例,吻合口狭窄发生率为14.8%(23/155)较B组68.4%(67/98)明显减少,差异有统计学意义(p<0.05);B组并发食管支气管瘘5例,食管主动脉瘘3例,死亡7例,吻合口复发为3.1%(3/98)。结论 对术后确诊或疑似吻合口瘘的患者,早期行内镜检查是必要和安全的。选择经内镜治疗后患者瘘口愈合、恢复进食时间较单纯保守治疗明显缩短,住院时间及费用也相应减少,远期无严重并发症,吻合口狭窄、复发率也明显下降,具有较好的临床疗效。更多还原

【Abstract】 Objective Analyzed the effect of endoscopic diagnosis and treatment on postoperative anastomotic fistula of esophageal or cardiac cancer.Method Comparative analysis between 155 cases with endoscopic treatment(A group) and 98 cases without endoscopic treatment(group B) of anastomotic fistula after operation of esophageal or gastric cardia from January 2010 to June 2014.Results The two groups of patients are successfully completed endoscopic diagnosis or treatment,the average days of eating recovery:A group was(6.5 ± 3.7) d,obviously shorter than group B(14.8 ±8.1) d;the mean postoperative hospital stay:A group was(7.8 ±4.0) d,shorter than group B(18.4 ±9.3) d;the average hospitalization costs:A group was(56.358±0.923) thousand yuan,less than group B(129.36 + 3.854) thousand yuan.All the difference was statistically significant(P<0.05).Two groups of patients were followed up for 12 momths:A group with no death or complications,no anastomotic recurrence;Anastomotic stricture rate was 14.8%(23/155),lower than group B(68.4%,67/98).The difference was statistically significant(P<0.05);In group B,there were 5 cases with bronchial fistula of esophagus,3 cases with aorta esophageal fistula,7 cases of deaths.Anastomotic recurrence was 3.1%(3/98).Conclusions The patients were confirmed or suspected of anastomotic fistula,early endoscopy is necessary and safe.Patients after endoscopic treatment need shorter time than conservative treatment alone in fistula healing,eating recovery.Hospital stay and costs are reduced accordingly,Patients have better clinical results:no serious long-term complications,significantly decreased rate of anastomotic stricture recurrence.更多还原