中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2010年
3期
205-208
,共4页
唐云%李荣%陈凛%卫勃%武现生
唐雲%李榮%陳凜%衛勃%武現生
당운%리영%진름%위발%무현생
胃肿瘤%胃瘘%肠瘘%胃切除术%营养支持
胃腫瘤%胃瘺%腸瘺%胃切除術%營養支持
위종류%위루%장루%위절제술%영양지지
Stomach neoplasms%Gastric fistula%Intestinal fistula%Gastrectomy%Nutritional support
目的 总结胃癌切除术后胃肠道瘘的治疗经验,以提高对胃癌切除术后胃肠道瘘的治疗水平.方法 对1997年1月至2006年12月在北京解放军总医院治疗的胃癌切除术后19例吻合El瘘和18例十二指肠残端瘘共37例胃肠道瘘患者进行回顾性分析.结果 本组37例均加强了瘘口附近的腹腔引流,采用了持续胃肠减压,先给予肠外营养支持、然后从肠外营养支持逐步过渡到肠内营养支持的治疗手段.32例在肠外营养液中强化了谷氨酰胺,31例使用了生长抑素,13例在吻合口瘘愈合期加用了生长激素.9例瘘口于术后21-30d自愈,24例于30-60d内愈合,2例于60.81 d内愈合.2例死亡,其中1例食管空肠吻合口瘘因严重的左侧胸腔、肺部感染及腹腔感染于术后42 d死亡.另1例十二指肠残端瘘因瘘口周围严重感染和急性腹腔内出血于术后62 d死亡.结论 保证腹腔引流的通畅、持续胃肠减压,特别是肠外结合肠内营养支持、强化谷氨酰胺、生长抑素及生长激素等措施,是促进胃癌切除术后胃肠道瘘愈合的重要手段.
目的 總結胃癌切除術後胃腸道瘺的治療經驗,以提高對胃癌切除術後胃腸道瘺的治療水平.方法 對1997年1月至2006年12月在北京解放軍總醫院治療的胃癌切除術後19例吻閤El瘺和18例十二指腸殘耑瘺共37例胃腸道瘺患者進行迴顧性分析.結果 本組37例均加彊瞭瘺口附近的腹腔引流,採用瞭持續胃腸減壓,先給予腸外營養支持、然後從腸外營養支持逐步過渡到腸內營養支持的治療手段.32例在腸外營養液中彊化瞭穀氨酰胺,31例使用瞭生長抑素,13例在吻閤口瘺愈閤期加用瞭生長激素.9例瘺口于術後21-30d自愈,24例于30-60d內愈閤,2例于60.81 d內愈閤.2例死亡,其中1例食管空腸吻閤口瘺因嚴重的左側胸腔、肺部感染及腹腔感染于術後42 d死亡.另1例十二指腸殘耑瘺因瘺口週圍嚴重感染和急性腹腔內齣血于術後62 d死亡.結論 保證腹腔引流的通暢、持續胃腸減壓,特彆是腸外結閤腸內營養支持、彊化穀氨酰胺、生長抑素及生長激素等措施,是促進胃癌切除術後胃腸道瘺愈閤的重要手段.
목적 총결위암절제술후위장도루적치료경험,이제고대위암절제술후위장도루적치료수평.방법 대1997년1월지2006년12월재북경해방군총의원치료적위암절제술후19례문합El루화18례십이지장잔단루공37례위장도루환자진행회고성분석.결과 본조37례균가강료루구부근적복강인류,채용료지속위장감압,선급여장외영양지지、연후종장외영양지지축보과도도장내영양지지적치료수단.32례재장외영양액중강화료곡안선알,31례사용료생장억소,13례재문합구루유합기가용료생장격소.9례루구우술후21-30d자유,24례우30-60d내유합,2례우60.81 d내유합.2례사망,기중1례식관공장문합구루인엄중적좌측흉강、폐부감염급복강감염우술후42 d사망.령1례십이지장잔단루인루구주위엄중감염화급성복강내출혈우술후62 d사망.결론 보증복강인류적통창、지속위장감압,특별시장외결합장내영양지지、강화곡안선알、생장억소급생장격소등조시,시촉진위암절제술후위장도루유합적중요수단.
Objective To summarize the treatment experiences in gastrointestinal leaJcage atter gastrectomy for gastric cancer. Mehods From January 1997 to December 2006 the clinical data of 37 cases of gastrointestinal leakage including anastomotic leakage in 19 cases and duodenal stump leakage in 18 after gastrectomy for gastric cancer in People's Liberation Army General Hospital were analyzed retrospectively. Results All of the Cases were treated with abdominal drainage,continuous gastrointinal decomnression and parenteral nutrition combined with enteral nutrition.There were 32 cases receiving glutamine enrichment nutrition support,31 ases used somatostatin,13 cases received supplemented recombinarlt human growth hormone.Fistula healed in 21~30 d in 9 cases after gastrectomy,in the other 24 cases fistula healed in 30-60 d,while it healed in 60~81 d in the remaining 2 cases.Two died of leakage associated complications after gastrectomy for gastric cancer including anastomotlc leakage follwing esophagojejunostomy complicated by severe thoracic and lung infection in one and duodenal stump leakage complicated by severe abdominal cavity sepsis and hemorrhage in the other. Conclusion Patent and effective abdominal cavity drainage,continuous gastrointestinal decompression,parenteral nutrition combined with enteral nutrition,glutarnine,somatostafin and recombinant human growth hormone are the'mportant factors for the healing of gastrointestinal leakage after gastrectomy tor gastric cancer.