中国医学前沿杂志（电子版）2017，Vol.9Issue(5)：15-18,4.DOI:10.12037/YXQY.2017.05-04
腹腔镜辅助根治性全胃切除术后食管空肠吻合口漏诊治方法的改进
Improvement of diagnosis and treatment of esophagojejunal anastomotic leakage after laparoscopic assisted total gastrectomy
摘要
Abstract
Objective Esophagojejunal anastomosis leakage is one of the severe complications after laparoscopic total gastrectomy and affects the long-term survival rate. Our aim is to explore an effective draninage approach to shorten treatment period. Method 3 patients who developed esophagojejunal anastomosis after laparoscopic total gastrectomy in Chinese Academy of Medical Sciences and Peking Union Medical College were identified and investigated. The diagnosis was established by changes of drainage, exit of methylene blue through the drain, upper digestive tract radiography and abdominal computed tomography (CT) scan on the 4th, 5th and 6th postoperative day respectively. Combined with other comprehensive treatment including fasting, continuous gastrointestinal decompression, parenteral and enteral nutrition, and broad-spectrum antibiotics, the effective management of drainage tube was achieved through the method of "T-tube drainage of the bile duct". The drainage tube can be clamped if the patient's body temperature was normal after two weeks. And after 24 ~ 48 hours later, oral feeding could be allowed. Then we clamped the drainage tube intermittently and retreated 1~2 cm every 3~5 days until the removal of drainage tube. Result 3 patients were all cured and discharged. The mean time of oral feeding was 20 days (range: 16 ~ 23 days) after diagnosis of anastomotic leakage; the mean time of removal of drainage tube was 28 days (range: 25 ~ 33 days); the hospitalization time was 30 days (range: 27 ~ 34 days). All 3 patients were followed up 3 ~ 16 months and no recurrent fever and abdominal pain were observed. Conclusion On the basis of fasting, continuous gastrointestinal decompression, parenteral and enteral nutrition, and broad-spectrum antibiotics, the effective management of drainage tube is achieved through the method of"T-tube drainage of the bile duct", which shortened the cure time of esophagojejunal anastomotic leakage.关键词
腹腔镜根治性全胃切除术/食管空肠吻合口漏/诊治方法Key words
Laparoscopic radical total gastrectomy/Esophagojejunal leakage/Diagnosis and treatment引用本文复制引用
马福海,王杰,刘志,何纪恩,解亦斌,郭春光,田艳涛..腹腔镜辅助根治性全胃切除术后食管空肠吻合口漏诊治方法的改进[J].中国医学前沿杂志（电子版）,2017,9(5):15-18,4.基金项目
北京市科技计划项目(Z161100000110045) （Z161100000110045）
吴阶平医学基金会临床科研专项资助基金项目(320.6750.15276) （320.6750.15276）
北京中医药科技发展资金项目(JJ2015-63) （JJ2015-63）
