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

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.%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.