CAJ | 학술논문

目的：评价CT引导下置管引流治疗胃癌切除术后胃肠道瘘的疗效。方法：回顾性分析2009年7月-2013年12月共17例胃癌切除术后吻合口瘘及十二指肠残端瘘患者的病例资料，所有病例均行CT 引导下经皮穿刺放置引流管交替冲洗引流或持续冲洗引流，并结合持续胃肠减压、抗感染、肠外、肠内营养支持等综合治疗措施进行治疗。结果：所有病例均在CT引导下顺利置入引流管，7例置入单根引流管，10例置入两根引流管。16例（94％）经过引流结合抗感染、营养支持等治疗4～12周后CT复查原积液逐渐吸收、消失，消化道碘水造影显示胃空肠吻合口瘘及食管空肠吻合口瘘闭合，CT扫描显示十二指肠残端瘘残端周围积液腔吸收、消失。16例随访3～6个月胃肠道瘘无复发，1例食管空肠吻合口瘘经穿刺引流及再次手术后仍死于严重感染。结论：CT引导下经皮穿刺放置引流管结合营养支持等综合治疗是胃癌切除术后胃肠道瘘的有效治疗手段，尤其是多根引流管结合生理盐水冲洗引流可能有助于提高引流效果，促进瘘口愈合。
목적：평개CT인도하치관인류치료위암절제술후위장도루적료효。방법：회고성분석2009년7월-2013년12월공17례위암절제술후문합구루급십이지장잔단루환자적병례자료，소유병례균행CT 인도하경피천자방치인류관교체충세인류혹지속충세인류，병결합지속위장감압、항감염、장외、장내영양지지등종합치료조시진행치료。결과：소유병례균재CT인도하순리치입인류관，7례치입단근인류관，10례치입량근인류관。16례（94％）경과인류결합항감염、영양지지등치료4～12주후CT복사원적액축점흡수、소실，소화도전수조영현시위공장문합구루급식관공장문합구루폐합，CT소묘현시십이지장잔단루잔단주위적액강흡수、소실。16례수방3～6개월위장도루무복발，1례식관공장문합구루경천자인류급재차수술후잉사우엄중감염。결론：CT인도하경피천자방치인류관결합영양지지등종합치료시위암절제술후위장도루적유효치료수단，우기시다근인류관결합생리염수충세인류가능유조우제고인류효과，촉진루구유합。
Objective:To evaluate the effectiveness of percutaneous catheter drainage under CT guidance in the treat-ment of gastrointestinal leakage after gastrectomy for gastric cancer.Methods:From July 2009 to December 2013,the clinical data of 1 7 cases of gastrointestinal leakage including anastomotic leakage in 1 3 cases and duodenal stump leakage in 4 cases after gastrectomy for gastric cancer were analyzed retrospectively.All the patients were treated with percutaneous catheter drainage under CT guidance combined with other comprehensive treatment including continuous gastrointestinal decompres-sion,administration of antibiotic and parenteral nutrition and enteral nutrition.Results:Percutaneous catheter drainage under CT guidance was successfully performed in all the patients.Single catheter was placed in 7 cases and two catheters were placed in 10 cases.After percutaneous catheter drainage combined with other comprehensive treatment,leakage closure was achieved in 16 (94%)patients and fluid collection around leakage had gradually disappeared on CT images in 4 to 12 weeks of follow-up.Anastomotic leakage closure was confirmed by gastrointestinal fluoroscopy using nonionic contrast agent and duodenal stump leakage was confirmed with CT scan.All 1 6 cases were followed up 3 to 6 months and no recurrence of gas-trointestinal leakage was observed.One patient died of leakage associated complications including severe infection even after percutaneous catheter drainage and re-operation.Conclusion:Percutaneous catheter drainage under CT guidance combined with other comprehensive treatment was effective methods for gastrointestinal leakage after gastrectomy for gastric cancer. More than one catheter placement around leakage with sterile saline flushing and drainage maybe more efficacious in promo-ting leakage closure.