本文選題：食管-胃吻合口瘺 + 數(shù)字減影血管造影　； 參考：《蘇州大學(xué)》2016年碩士論文

【摘要】：目的胸腔內(nèi)食管-胃吻合口瘺是食管癌、賁門癌術(shù)后最嚴(yán)重的并發(fā)癥之一,其診斷和治療尚無明確有效的方法。近來,我單位開展了一項對于胸腔內(nèi)食管-胃吻合口瘺的新的診療模式并取得了一定的效果,本文旨在探討早期DSA下瘺口造影、放置瘺口引流管沖洗和胃鏡下鈦夾夾閉的診治模式處理胸腔內(nèi)食管-胃吻合口瘺的可行性。方法回顧性分析2007年1月至2014年12月蘇州大學(xué)附屬第一醫(yī)院胸外科食管癌、賁門癌根治術(shù)后發(fā)生胸腔內(nèi)吻合口瘺55例患者的臨床資料,其中男36例,女19例,年齡49~81歲(平均67±6歲)。原發(fā)病為食管中段癌42例,食管下段癌11例及賁門癌2例。根據(jù)診治方法的差異分成傳統(tǒng)診療組和新模式診療組。其中傳統(tǒng)診療組31例,為2007年1月至2011年11月病例,所有患者采取傳統(tǒng)診治法,在懷疑吻合口瘺后行食管造影以明確診斷,充分引流及感染控制后置入食管支架;新模式診療組24例,為2011年3月至2014年12月病例,所有患者采取新模式診治法,在懷疑吻合口瘺時立即在DSA下直接吻合口造影,明確瘺口位置及探查瘺腔形態(tài)及大小,根據(jù)探查情況行瘺腔內(nèi)置管引流或沖洗,控制感染后逐步退出瘺腔內(nèi)引流管,后經(jīng)胃鏡鈦夾夾閉瘺口,少數(shù)鈦夾治療失敗者行食管支架置入。分別采用t檢驗、卡方檢驗和精確概率法比較兩組資料的術(shù)前一般情況、吻合口瘺確診時間、確診吻合口瘺后住院時間、嚴(yán)重并發(fā)癥發(fā)生率和死亡率。結(jié)果兩組資料的術(shù)前一般情況無統(tǒng)計學(xué)差異(P0.05);相較于傳統(tǒng)診療組,新模式診療組吻合口瘺確診時間顯著縮短(1.2±0.8比3.6±2.2,t=5.212,P0.001),確診吻合口瘺后住院時間明顯縮短(26.4±11.9比55.5±25.4,t=4.992,P0.001)。兩組出現(xiàn)嚴(yán)重并發(fā)癥的例數(shù)分別為15例和4例,死亡例數(shù)分別為7例和1例,相對于傳統(tǒng)診療組,新模式診療組嚴(yán)重并發(fā)癥發(fā)生率顯著下降(16.7%比48.4%,?2=6.019,P=0.014),總體死亡率無統(tǒng)計學(xué)差異(4.2%比22.6%,P=0.119)。結(jié)論在我們的臨床初步研究中,早期介入診斷、早期瘺腔內(nèi)置管引流或沖洗及后期胃鏡下鈦夾夾閉的診治新模式較傳統(tǒng)的保守治療模式具有一定的優(yōu)勢,不僅能夠明顯縮短胸腔內(nèi)食管-胃吻合口瘺的診斷和治療周期,降低嚴(yán)重并發(fā)癥發(fā)生率,而且總體死亡率也明顯下降,值得在臨床上推廣。
[Abstract]:Objective the thoracic esophagogastric anastomotic fistula is one of the most serious complications after the operation of the esophagus and cardia cancer. There is no clear and effective method for diagnosis and treatment. Recently, our unit has developed a new diagnosis and treatment model for the esophagogastric anastomotic fistula in the thoracic cavity and has achieved some effect. This paper aims to explore the early DSA fistula. The feasibility of treating intrapleural esophagogastric anastomotic fistula with fistula drainage tube irrigation and endoscopic titanium clip clipping. Methods the clinical data of 55 patients with esophageal carcinoma in the Department of thoracic surgery of First Hospital Affiliated to Suzhou University from January 2007 to December 2014 after radical resection of cardia cancer were analyzed retrospectively, including 36 male patients. There were 19 cases of female, 19 years old (average 67 + 6 years). The primary disease was 42 cases of middle esophageal carcinoma, 11 cases of lower esophageal carcinoma and 2 cases of cardia cancer. According to the difference of diagnosis and treatment, the traditional diagnosis and treatment group was 31 cases from January 2007 to November 2011. All patients took traditional diagnosis and treatment method and suspected anastomosis. After fistula, esophagography was performed to make a clear diagnosis, full drainage and infection control were placed into the esophageal stent; 24 cases of the new mode diagnosis and treatment group were from March 2011 to December 2014. All the patients were treated with new mode of diagnosis and treatment. The direct anastomosis examination under DSA was taken immediately when the anastomotic fistula was suspected, and the location of the fistula and the shape and size of the fistula were determined. The fistula cavity was drained or washed in the fistula cavity. After controlling the infection, the fistula endovascular drainage tube was gradually withdrawn from the fistula, and the fistula was closed through the titanium clip of the gastroscope. A few titanium clips were used to treat the losers. The t test, the chi square test and the accurate probability method were used to compare the general conditions of the two groups of data, the diagnosis time of anastomotic fistula, and the diagnosis and anastomosis. The time of hospitalization after oral fistula, the incidence of severe complications and mortality. Results there was no statistical difference between the two groups before operation (P0.05). Compared with the traditional diagnosis and treatment group, the time of diagnosis of anastomotic fistula was significantly shortened (1.2 + 0.8, 3.6 + 2.2, t=5.212, P0.001), and the hospitalization time was significantly shorter (26.4 + 11.9) after the diagnosis of anastomotic fistula (26.4 + 11.9). 55.5 + 25.4, t=4.992, P0.001). The number of cases of severe complications in the two groups were 15 and 4, the number of death cases was 7 and 1, compared with the traditional diagnosis and treatment group, the incidence of severe complications in the new model group decreased significantly (16.7% to 48.4%, 2=6.019, P=0.014), and the overall mortality rate was not statistically different (4.2% than 22.6%, P=0.119). The conclusion was in me. In our preliminary clinical study, early interventional diagnosis, early fistula cavity internal tube drainage or rinse and late gastroscopy titanium clip closure have some advantages compared with traditional conservative treatment mode, not only can obviously shorten the diagnosis and treatment cycle of esophagogastric anastomotic fistula in the thoracic cavity, but also reduce the incidence of serious complications. The overall mortality rate is also significantly lower, which is worth promoting in clinical practice.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R735

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