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浙江大学学报（医学版）
浙江大学学报（医学版）  2017, Vol. 46 Issue (6): 637-642    DOI: 10.3785/j.issn.1008-9292.2017.12.10
原著     
内镜引导下吻合口瘘冲洗治疗食管胃吻合口瘘合并瘘旁脓肿临床疗效观察
祝子逸*(),郦志军,何正富,王云震
浙江大学医学院附属邵逸夫医院胸外科, 浙江 杭州 310016
Endoscopic trans-fistula drainage for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy
ZHU Ziyi*(),LI Zhijun,HE Zhengfu,WANG Yunzhen
Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
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摘要：

目的: 分析内镜引导下吻合口瘘冲洗（ETFD）治疗食管胃吻合口瘘合并瘘旁脓肿的疗效和安全性。方法: 收集浙江大学医学院附属邵逸夫医院胸外科2012年2月至2017年2月食管癌术后吻合口瘘合并瘘旁脓肿的15例患者的资料，其中7例施行ETFD治疗，8例采用传统治疗方法。统计分析患者治疗后炎症指标和瘘口变化、食管癌术后住院天数和住院总费用等。结果: 7例ETFD治疗患者吻合口瘘均成功愈合，患者外周血白细胞计数恢复正常时间和C反应蛋白量开始下降时间较传统治疗患者提前，瘘口愈合时间、食管癌术后住院天数缩短，住院总费用降低（均P < 0.05）。结论: ETFD治疗食管癌术后食管胃吻合口瘘合并瘘旁脓肿安全有效。
关键词： 食管肿瘤/外科学;  手术后并发症;  吻合术, 外科;  胃瘘/治疗;  食管瘘/治疗;  内窥镜检查;  引流术;  脓肿/治疗;  治疗结果    
Abstract:

Objective: To evaluate the efficiency and safety of endoscopic trans-fistula drainage (ETFD) for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy. Methods: Among 456 esophageal cancer patients receiving esophagectomy between February 2012 and February 2017 in Sir Run Run Shaw Hospital, 15 cases were diagnosed as gastroesophageal anastomotic fistula with para-fistula abscess after surgery. Seven cases received ETFD treatment (ETFD group), and 8 cases received conventional treatment (control group). Recovery of inflammatory markers and fistula, length of hospital stay after esophagectomy and total medical expenses were compared between ETFD group and control group. Results: All patients recovered in ETFD group. Time of white cell count returning to normal and decline of C-reactive protein, time of fistula healing and length of hospital stay after esophagectomy in ETFD group were significantly shorter than those of control group (all P < 0.05). And medical expenses in ETFD group was also lower (P < 0.05). Conclusion: ETFD is effective and safe for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy.
Key words: Esophageal neoplasms/surgery    Postoperative complications    Anastomosis, surgical    Gastric fistula/therapy    Esophageal fistula/therapy    Endoscopy    Drainage    Abscess/therapy    Treatment outcome
收稿日期: 2017-09-28 出版日期: 2017-12-25
CLC:  R65  
基金资助: 浙江省医药卫生科技计划(2015KYA130)
通讯作者: 祝子逸     E-mail: youbing@zju.edu.cn
作者简介: 祝子逸(1982-), 男, 博士, 主治医师, 主要从事肺癌、食管癌等胸部恶性肿瘤的研究; E-mail:youbing@zju.edu.cn; https://orcid.org/0000-0001-8890-7894
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引用本文:

祝子逸,郦志军,何正富,王云震. 内镜引导下吻合口瘘冲洗治疗食管胃吻合口瘘合并瘘旁脓肿临床疗效观察[J]. 浙江大学学报（医学版）, 2017, 46(6): 637-642.

ZHU Ziyi,LI Zhijun,HE Zhengfu,WANG Yunzhen. Endoscopic trans-fistula drainage for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy. J Zhejiang Univ (Med Sci), 2017, 46(6): 637-642.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2017.12.10    或    http://www.zjujournals.com/med/CN/Y2017/V46/I6/637

图 1  上消化道造影检查示患者食管吻合口旁一纵隔脓肿(箭头所示)
图 2  内镜引导下吻合口瘘冲洗以及营养支持治疗食管瘘
图 3  内镜引导下吻合口瘘冲洗治疗食管胃吻合口瘘合并瘘旁脓肿典型病例的内镜下表现
图 4  内镜引导下吻合口瘘冲洗治疗食管胃吻合口瘘合并瘘旁脓肿典型病例的CT表现
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