本文選題：氣管食管瘺　切入點：切割吻合器　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討切割吻合器在良性獲得性氣管食管瘺手術(shù)治療中的近遠期臨床效果。方法回顧分析2005年4月至2016年11月鄭州大學(xué)人民醫(yī)院胸外科應(yīng)用氣管食管瘺切開分別修補術(shù)治療的良性獲得性氣管食管瘺患者,排除合并氣管或(和)食管狹窄者,排除合并氣管或(和)食管損傷需重建者,共計入組41例。根據(jù)術(shù)中閉合瘺口時是否使用一次性切割吻合器分組,分為常規(guī)組與切割吻合器組。運用統(tǒng)計學(xué)方法對比分析2組患者手術(shù)時間、術(shù)中出血量、拔除引流管時間、術(shù)后住院時間,統(tǒng)計2組患者術(shù)后縫合口破裂、再瘺、感染、狹窄及死亡的發(fā)生率。結(jié)果全組41例均成功實施氣管食管瘺切開分別修補術(shù)。常規(guī)組共計19例:術(shù)后出現(xiàn)瘺口縫合處破裂4例(21.05%),感染3例(15.79%),再瘺1例(5.26%),死亡1例(5.26%)。切割吻合器組共計22例:術(shù)后出現(xiàn)瘺口縫合處破裂1例(4.55%)。相比,切割吻合器組患者術(shù)后并發(fā)癥發(fā)生率明顯低于常規(guī)組。常規(guī)組患者平均手術(shù)時間為(278.9±39.5)min,術(shù)中出血量為(198.4±102.4)ml,拔除引流管時間為(12.8±6.6)d,術(shù)后住院時間為(19.5±4.9)d。切割縫合器組患者平均手術(shù)時間為(228.2±37.9)min,術(shù)中出血量為(118.2±74.6)ml,拔除引流管時間為(9.5±2.9)d,術(shù)后住院時間為(17.0±2.9)d。經(jīng)統(tǒng)計學(xué)分析,2組患者手術(shù)時間和術(shù)中出血量有明顯統(tǒng)計學(xué)差異,拔除引流管時間和術(shù)后住院時間未見明顯統(tǒng)計學(xué)差異。結(jié)論應(yīng)用切割吻合器直接關(guān)閉并隔離治療良性獲得性氣管食管瘺的手術(shù)方式相較于常規(guī)氣管食管瘺切開分別修補術(shù)優(yōu)勢明顯,閉合瘺口更加確切牢靠,更有效的較少術(shù)中污染,同時可以簡化手術(shù)流程,明顯縮短手術(shù)時間,減少術(shù)中出血,有效避免術(shù)中副損傷及術(shù)后近遠期的并發(fā)癥發(fā)生,效果肯定,值得推廣。
[Abstract]:Objective to investigate the clinical effect of cutting stapler in the treatment of benign tracheoesophageal fistula. Methods from April 2005 to November 2016, retrospective analysis of tracheoesophageal fistula was performed in the Department of Thoracic surgery, Zhengzhou University people's Hospital. Do not repair benign acquired tracheoesophageal fistula, The patients with trachea or / and esophageal stricture were excluded, and those complicated with trachea or / and esophageal injury needed to be reconstructed. A total of 41 cases were divided into groups according to whether or not one-off cutting stapler was used to close the fistula during operation. The patients in the two groups were divided into two groups: the operation time, the amount of blood lost during operation, the time of pulling out the drainage tube, the time of hospitalization after operation, the rupture of the suture, the recurrence of fistula and the infection of the two groups. Results the tracheoesophageal fistula was repaired successfully in 41 cases. 19 cases in the routine group: 4 cases had rupture of fistula suture after operation, 3 cases had infection, 1 case had fistula 5.26%, and 1 case died. There were 22 cases in the group of cutting stapler: 1 case had rupture of fistula suture after operation, and 4.55 cases had ruptured after operation. The average operative time, blood loss, drainage tube and hospital stay were 278.9 鹵39.5 min, 198.4 鹵102.4 ml, 12.8 鹵6.6 d, 19.5 鹵4.9 d, respectively. The average operative time was 228.2 鹵37.9 min, the amount of intraoperative bleeding was 118.2 鹵74.6 ml, the time of removing drainage tube was 9.5 鹵2.9 days, and the postoperative hospitalization time was 17.0 鹵2.9 days. There was no significant difference between the time of extubation and the length of hospital stay after operation. Conclusion the operative method of treating benign acquired tracheoesophageal fistula by cutting stapler is better than that of conventional tracheoesophageal fistula. Do not repair the advantages of obvious, The closure of fistula is more reliable, more effective and less contaminated during operation. At the same time, it can simplify the operation process, shorten the operation time, reduce the bleeding during the operation, and effectively avoid the side injury during operation and the complications in the near and long term after operation, and the effect is positive. It is worth popularizing.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R655

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本文編號：1607185