【摘要】：目的 分析腹腔鏡下空腸造瘺術(shù)在微創(chuàng)食管手術(shù)中的安全性、可行性以及通過空腸造瘺管進行腸內(nèi)營養(yǎng)支持的臨床效果。 方法 回顧性分析浙江大學醫(yī)學院附屬第二醫(yī)院胸外科2014年1月至2015年3月間行腹腔鏡下空腸造瘺術(shù)的69例患者臨床資料,其中男性58例,女性11例,平均年齡59.2歲,術(shù)前診斷為食管癌65例,其中63例為可根治性食管癌,于微創(chuàng)食管癌切除術(shù)中附加行空腸造瘺術(shù),2例為晚期食管癌,僅單獨行空腸造瘺術(shù)。1例自發(fā)性食管破裂,1例食管腐蝕傷,1例食管內(nèi)異物致食管穿孔,1例食管平滑肌瘤均各自行相應(yīng)手術(shù)及空腸造瘺術(shù)。 結(jié)果 67例患者均成功施行了腹腔鏡下空腸造瘺術(shù),有2例術(shù)中中轉(zhuǎn)開腹。術(shù)后1例因心跳呼吸驟停死亡,1例出現(xiàn)不全性腸梗阻,1例出現(xiàn)腹壁感染。住院期間均未發(fā)生空腸造瘺管堵塞、移位、滑脫、斷裂等情況。患者術(shù)后體重、體重指數(shù)較術(shù)前下降(P0.05)。通過空腸造瘺管滴入腸內(nèi)營養(yǎng)液,患者術(shù)后第9天血清白蛋白濃度較術(shù)后第1天呈上升趨勢(P0.05)。 結(jié)論 腹腔鏡下空腸造瘺術(shù)在微創(chuàng)食管手術(shù)中是安全可行的,手術(shù)相關(guān)并發(fā)癥發(fā)生率及死亡率低,在需經(jīng)腹的微創(chuàng)食管手術(shù)中附加完成空腸造瘺術(shù),可為食管疾病尤其是食管癌患者術(shù)后提供早期、長期的腸內(nèi)營養(yǎng)支持,有利于患者的快速康復。
[Abstract]:Objective to analyze the safety and feasibility of laparoscopic jejunostomy in minimally invasive esophageal surgery and the clinical effect of enteral nutrition support through jejunostomy tube. Methods the clinical data of 69 patients undergoing laparoscopic jejunostomy from January 2014 to March 2015 in the second affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed, including 58 males and 11 females, with an average age of 59.2 years. 65 cases of esophageal carcinoma were diagnosed before operation, 63 cases of which were radical esophageal carcinoma, 2 cases of advanced esophageal carcinoma were treated with jejunostomy during minimally invasive resection of esophageal carcinoma. Jejunostomy was performed only in 1 case of spontaneous esophageal rupture and 1 case of esophageal corrosion injury. One case of esophageal perforation caused by foreign body in esophagus and 1 case of esophageal leiomyoma were treated with corresponding operation and jejunostomy respectively. Results Laparoscopic jejunostomy was performed successfully in all 67 patients. One case died of cardiac and respiratory arrest after operation, 1 case had incomplete intestinal obstruction and 1 case had abdominal wall infection. There was no obstruction, displacement, slippage and rupture of jejunostomy tube during hospitalization. The body weight and body mass index of the patients after operation were lower than those before operation (P0.05). The concentration of serum albumin increased on the 9th day after operation compared with that on the first day after operation (P0.05). Conclusion Laparoscopic jejunostomy is safe and feasible in minimally invasive esophageal surgery with low incidence of complications and mortality. It can provide early and long term enteral nutrition support for patients with esophageal diseases, especially for patients with esophageal cancer.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R65

【參考文獻】

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1 尹路,陳桂明,錢{囈，

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