CAJ | 학술논문

目的：探讨食管癌术后胸内消化道瘘发生的原因及诊治方法。方法2007年1月至2013年12月共427例患者行食管癌切除术，术后26例发生胸内消化道瘘，其中 7例行二次开胸手术，其余19例采用保守治疗。26例患者均常规留置十二指肠营养管，给予积极的肠内营养支持治疗，并进行充分脓腔及胃液引流，以及持续的胸腔冲洗治疗。结果胸内消化道瘘发生率为6．09％（26／427），其中胃壁瘘6例，吻合口瘘20例。二次开胸手术 7例患者全部临床治愈，无死亡病例。保守治疗19例患者中，治愈14例，死亡5例。二次开胸手术患者住院时间及瘘口愈合时间均低于本组平均水平。结论食管癌根治术后3天以内发生的早期瘘，应争取二次开胸手术。胸内消化道瘘须进行充分脓腔及胃液引流、胸腔冲洗以及肠内营养支持治疗。
목적：탐토식관암술후흉내소화도루발생적원인급진치방법。방법2007년1월지2013년12월공427례환자행식관암절제술，술후26례발생흉내소화도루，기중 7례행이차개흉수술，기여19례채용보수치료。26례환자균상규류치십이지장영양관，급여적겁적장내영양지지치료，병진행충분농강급위액인류，이급지속적흉강충세치료。결과흉내소화도루발생솔위6．09％（26／427），기중위벽루6례，문합구루20례。이차개흉수술 7례환자전부림상치유，무사망병례。보수치료19례환자중，치유14례，사망5례。이차개흉수술환자주원시간급루구유합시간균저우본조평균수평。결론식관암근치술후3천이내발생적조기루，응쟁취이차개흉수술。흉내소화도루수진행충분농강급위액인류、흉강충세이급장내영양지지치료。
Objective To investigate the cause, diagnosis and treatment of thoracic gastrointestinal fistula after esophagus cancer operation. Methods Esophagectomy was performed in 427 patients with esophageal cancer from January 2007 to December 2013 in our hospital. Gastrointestinal fistula occurred post-operatively in 26 patients..Of them with gastrointestinal fistula,7 patients underwent reoperation and 19 cases received conservative treatment including gastrointestinal decompression , thoracic cavity washing,vomica and gastric juice drainage. Enteral nutrition support by duodenal nutrition tube were performed in all 26 patients. Results The rate of TGF was 6.09% (26/427), including 6 gastric remnant fistula and 20 gastroesophageal anastomotic fistula. Seven patients with reoperation were cured due to finding in 3 days. Fourteen cases were cured in 19 patients with conservative treatment and 5 died. Conclusion Esophageal reconstruction should be performed in the patients of early fistula which happens in 3 days after operation. Vomica drainage , adequate gastric juice drainage , thoracic cavity washing and active enteral nutrition support are necessary for treatment of thoracic gastrointestinal fistula after esophagus cancer operation.