胸段食管裂开的处理及吻合

A. Ihnatsiuk
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引用次数: 0

摘要

背景在治疗食管裂开及其吻合时,有必要完成以下任务:纵隔和胸膜腔的引流和卫生,补充蛋白质损失和能量成本,裂开闭合和目前化脓性并发症的治疗。客观的应用现代微创电视胸腔镜技术改善食管及其吻合口裂开的治疗效果。材料和方法。20例(男性15例(75%),女性5例(25%))食管及其吻合口裂开患者接受了治疗。患者的平均年龄为M±SD=55±10(CI(95%)=50-60;最小−35;最大−76)。体重指数平均值M±SD=20.98 kg/m2(CI(95%)=18.61-22.45;最小−15,82;最大−38,27)。后果手术治疗导致裂开的原因为:食管癌症-6(30.0%);食管憩室-4例(20.0%);贲门失弛缓症−2(10.0%);食管化学灼伤−4(20.0%);良性形成-4(20.0%)。裂开的临床表现发生在M±SD=170±61小时(CI(95%)=141-198)。结论。通过安装T形引流系统或将经胸膜管固定在裂开处的胸壁上对食管的裂开管理、食管胃吻合或食管胃肠吻合术能够保存食管或形成的导管,以减少手术压力以及干预的持续时间,并且被认为是一种适当的手术选择。
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DEHISCENCE MANAGEMENT OF THORACIC ESOPHAGUS AND ITS ANASTOMOSES
Background. When treating the dehiscence of the esophagus and its anastomoses, it is necessary to fulfil the following tasks: drainage and sanitation of the mediastinum and pleural cavity, replenishment of protein losses and energy costs, dehiscence closure and treatment of present purulent complications. Objective. To improve the treatment outcomes of esophageal and its anastomoses dehiscence using modern minimally invasive video-assisted thoracoscopic techniques. Material and methods. 20 patients (15 (75%) men and 5 women (25%)) with esophageal and its anastomoses dehiscence underwent treatment. The mean age of patients was M±SD = 55 ± 10 (CI (95%) = 50-60; min−35; max−76). Body mass index averaged M±SD = 20.98 kg/m2 (CI (95%) = 18.61-22.45; min−15,82; max−38,27). Results. The reasons for the surgical interventions resulting in dehiscence were as follows: esophageal cancer - 6 (30.0%); esophageal diverticula - 4 (20.0%); cardia achalasia − 2 (10.0%); esophageal chemical burn − 4 (20.0%); benign formations - 4 (20.0%). The development of clinical manifestations of dehiscence occurred at M±SD = 170 ± 61 hours, (CI (95%) = 141 - 198). Conclusions. The dehiscence management of the esophagus, esophagogastroanastomosis or esophagoenteroanastomosis either by installation of a T-shaped drainage system or fixation of transpleural tube to the thoracic wall at a place of dehiscence enables to preserve the esophagus or a created conduit, to reduce surgical stress as well as the duration of intervention and is regarded as an adequate surgical option.
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