Nigeiqianlm胃镜引导下放置十二指肠营养管治疗食管癌术后吻合口瘘的临床效果及应用体会
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摘要
目的:探讨胃镜引导下置入十二指肠营养管治疗食管癌术后并发吻合口瘘的临床效果及其应用体会。方法:在2008年1月至2011年9月入我科治疗的3126例食管癌手术患者中,49例术后并发吻合口瘘,患者经胃镜引导下置营养管于十二指肠降部,给予肠内营养治疗。术前1天、术后第5天、第7天、出院时分别测定患者体重,术后第1天起逐日观察患者肛门排气、排便等胃肠功能恢复情况。结果:49例患者中首次置管成功47例,成功率96%,置管时间10～20min,平均12min,置管及术后未发生严重并发症;鼻肠营养管肠内营养术后第7天体重下降≤2kg;肠道功能恢复快,术后肛门排气时间≤3d。结论:置入营养管的长度要较胃镜观察长约20cm并妥善固定可提高首次置管成功率。胃镜引导下置入十二指肠营养管对食管癌术后并发吻合口瘘的患者是一种安全、方便、有效的肠内营养途径,对此类患者的营养治疗起重要支持作用,具有临床应用价值。
Objective: To investigate the the gastroscope duodenum feeding tube placement and treatment of esophageal cancer postoperative anastomotic leakage in value.Methods: From January 2007 to September 2010 3126 cases of esophageal cancer surgery patients,49 patients with esophageal cancer postoperative set anastomotic leakage in patients with gastroscopy under the guidance of the feeding tube in the descending duodenum,enteral nutrition therapy.Patients' weight were measured in one day before surgery,five days after the first 7 days,and at discharged from hospital.Flatus,defecation and gastrointestinal function were observed daily from the first day after surgery.Results: 49 patients for the first time home tube success of the 49 cases,the success rate of 100%,catheter time 10-20min,an average of 12min,the catheter and postoperative no serious complications.Weight loss was less than 2kg seventh days after operation.Faster recovery of bowel function was found.Flatus was less than 3 days.Conclusion: Feeding tube should length than the gas-troscope observation about 20cm and properly secured,which can increase the success rate of tube for the first time.The gastroscope placed duodenal feeding tube in patients with anastomotic fistula after esophagectomy is a safe,convenient,effective enteral nutrition means to play an important role in the nutritional treatment of such patients.This method had wide range of clinical value.
Objective: To investigate the the gastroscope duodenum feeding tube placement and treatment of esophageal cancer postoperative anastomotic leakage in value.Methods: From January 2007 to September 2010 3126 cases of esophageal cancer surgery patients,49 patients with esophageal cancer postoperative set anastomotic leakage in patients with gastroscopy under the guidance of the feeding tube in the descending duodenum,enteral nutrition therapy.Patients' weight were measured in one day before surgery,five days after the first 7 days,and at discharged from hospital.Flatus,defecation and gastrointestinal function were observed daily from the first day after surgery.Results: 49 patients for the first time home tube success of the 49 cases,the success rate of 100%,catheter time 10-20min,an average of 12min,the catheter and postoperative no serious complications.Weight loss was less than 2kg seventh days after operation.Faster recovery of bowel function was found.Flatus was less than 3 days.Conclusion: Feeding tube should length than the gas-troscope observation about 20cm and properly secured,which can increase the success rate of tube for the first time.The gastroscope placed duodenal feeding tube in patients with anastomotic fistula after esophagectomy is a safe,convenient,effective enteral nutrition means to play an important role in the nutritional treatment of such patients.This method had wide range of clinical value.
引文
[1]宋怀先,曾聪普,赵延年,等.食管癌、胃癌术后早期肠内营养的临床观察[J].实用医院临床杂志,2009,6:65-66Song Huai-xian,Zeng Cong-pu,Zhao Yan-nian,et al.Early enteralnutrition after esophageal cancer or gastric cancer operations[J].Prac-tical Journal of clicical medicine,2009,6:65-66
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[8]Loske G,Schorsch T,Muller C.Intraluminal and intracavitary vacuumtherapy for esophageal leakage:a new endoscopic minimally invasiveapproach[J].Endoscopy,2011,43:540-544
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[10]李油山,汤兴松,胡健,等.比较两种肠内营养在食管癌术后吻合口瘘治疗中的临床体会[J].中国医学创新,2010,7:18-20.Li You-shan,Tang Xing-song,Hu Jian,et al.Comparison of two kindsof enteral nutrition for anastomotic fistula after esophageal carcinomaoperation[J].Medical innovation of china,2010,7:18-20
[11]魏祥志,张科,汪永和,等.贲门癌、食管癌术后早期肠内营养应用的体会[J].中国现代医生,2011,49(31):139-141Wei Xiang-zhi,Zhang Ke,Wang Yong-he,et al.The Application ofEarly Enteral Nutrition Treatment in Postoperative Patients withEsophageal or Cardiac Cancer[J].China Modern Doctor,2011,49(31):139-141
[12]霍前伦,黄和平.早期肠内营养对食管癌患者术后的影响[J].中国临床实用医学,2009,3(3):39-40Huo Qian-lun,Huang He-ping.The Influence on Nutrition Supportthrough Duodenal Nutrition Tube after Operation for Patients withEsophageal Carcinoma[J].China clinical practical medicine,2009,3(3):39-40
[13]周勇,魏静义,王文公,等.胃大部切除术后贲门癌及食管癌25例外科治疗[J].临床外科杂志,2010,18(2):111-112Zhou Yong,Wei Jing-yi,Wang Wen-gong,et al.Surgical treatmentfor carcinoma of gastric cardia and esophagus after subtotal gastrectomy:treatment experience of 25 cases[J].Journal of clinical surgery,2010,18(2):111-112
[14]袁培云,袁培江,李献哲,等.食管癌切除胃食管吻合术吻合口瘘及狭窄的预防[J].临床肺科杂志,2008,13(12):1612-1613Yuan Pei-yun,Yuan Pei-jiang,Li Xian-zhe,et al.Prevention of stomachleakage and stricture of esophagogastrtic anastomosis after resectionof esophageal carcinoma[J].Journal of clinical pulmonary medicine,2008,13(12):1612-1613
[15]尹国文,陈世晞,冯纯伟,等.新"三管法"介入治疗胸内食管胃吻合口瘘[J].介入放射学杂志,2008,17(11):812-814Yin Guo-wen,Chen Shi-xi,Feng Chun-wei,et al.The new"3-tube"in terventional therapy for gastroesophageal anastomotic fistula[J].Journal of interventional radiology,2008,17(11):812-814
[16]雷涛,张玲.三管法与两管法治疗胸内食管胃吻合口瘘的对比观察[J].临床外科杂志,2010,18(8):545-547Lei Tao,Zhang Ling.Three-and two-pipe methods for the treatmentof intrathoracic esophagogastric anastomotic fistula[J].Journal ofclinical surgery,2010,18(8):545-547
[17]刘法兵,阮征,郑健,等.胃镜辅助新三管法治疗严重胸内食管胃吻合口瘘[J].临床外科杂志,2011,19(9):622-623Liu Fa-bing,Ruan Zheng,Zheng Jian,et al.Gastroscopy-aided newthree-tube method for treatment of major intrathoracic esophagogas-tric anastomotic leakage[J].Journal of clinical surgery,2011,19(9):622-623
[18]秦永跃,丁旭青,刘国正,等.食管癌术后早期肠内营养的应用体会[J].中国肿瘤外科杂志,2009,1(5):305-306,309Qin Yong-yue,Ding Xu-qing,Liu Guo-zheng,et al.Clinical applica-tion of early enteral nutrition in postoperative esophagus cancer[J].Chinese Journal of surgical oncology,2009,1(5):305-306,309
[19]朱桥华,陈勇,曾庆乐,等.透视下双导丝置管法在食管癌术后吻合口瘘治疗中的应用[J].介入放射学杂志.2008,17:815-817.Zhu Qiao-hua,Chen Yong,Zeng Qing-le,et al.Fluoroscopy guideddouble-guidewire tube placement in treating anastomotic leakage afteresophagectomy for esophageal cancer[J].Journal of interventionalradiology,2008,16:840-841
[20]杨文峰.食管、贲门癌术后X线监视泥鳅导丝引导置入鼻-十二指肠营养管体会[J].肿瘤基础与临床,2009,22(3):245-246Yang Wen-feng.The Analyses of the Loach Guide Wire Placement ofNose-Duodenal Feeding Tube with X-Ray Monitor of EsophagealCancer and Cardiac Cancer Surgeries[J].Journal of basic and clinicaloncology,2009,22(3):245-246
[2]王峻峰,陈淑章,袁挺,等.早期肠内营养对老年食管癌患者术后恢复的影响[J].中国胸心血管外科临床杂志,2011,18:422-424Wang Jun-feng,Chen Shu-zhang,Yuan Ting,et al.Effect of EarlyEnteral Nutrition on Postoperative Recovery of Elderly Patients withEsophageal Cancer[J].Chinese Journal of Clinical Thoracic and Car-diovascular Surgery,2011,18:422-424
[3]俞永康,姜建青,郑轶峰,等.食管癌病人术后早期肠内营养的临床有效性研究[J].肠外与肠内营养,2010,17:227-229Yu Yong-kang,Jiang Jian-qing,Zheng Yi-feng,et al.Application ofearly enteral nutrition for patients with carcinoma of esophagus afteroperation[J].Parenteral and enteral untrition,2010,17:227-229
[4]Tuebergen D,Rijcken E,Mennigen R,et al.Treatment of thoracicesophageal anastomotic leaks and esophageal perforations with endo-luminal stents:efficacy and current limitations[J].J Gastrointest Surg,2008,12:1168-1176
[5]张德荣.食管癌术后颈部吻合口瘘不同途径营养支持[J].中国临床营养杂志,2008,16:156-159Zhang De-rong.Alternative Routes of Nutritional Supply for Postop-erative Neck Anastomotic Leakage in Patients with Esophageal Carci-noma[J].Chinese journal of clinical untrition,2008,16:156-159
[6]Rutegard M,Lagergren P,Rouvelas I,et al.Intrathoracic anastomoticleakage and mortality after esophageal cancer resection:a popula-tion-based study[J].Ann Surg Oncol,2011,19:99-103
[7]陈文树,潘小杰,欧德彬,等.食管癌术后吻合口瘘的预防和治疗探讨[J].临床外科杂志,2009,17(10):675-676Chen Wen-shu,Pan Xiao-jie,Ou De-bin,et al.Treatment and preven-tion of anastomotic leakage after operation of esophageal carcinoma[J].Journal of clinical surgery,2009,17(10):675-676
[8]Loske G,Schorsch T,Muller C.Intraluminal and intracavitary vacuumtherapy for esophageal leakage:a new endoscopic minimally invasiveapproach[J].Endoscopy,2011,43:540-544
[9]王雷,武玉清.早期肠内营养在食管癌术后感染预防中的效果研究[J].中华医院感染学杂志,2011,21:2928-2930Wang Lei,Wu Yu-qing.Study on efficacy of early enteral nutrition inpreventing infection after esophageal cancer surgery[J].Chinese journalof nosocomiology,2011,21:2928-2930
[10]李油山,汤兴松,胡健,等.比较两种肠内营养在食管癌术后吻合口瘘治疗中的临床体会[J].中国医学创新,2010,7:18-20.Li You-shan,Tang Xing-song,Hu Jian,et al.Comparison of two kindsof enteral nutrition for anastomotic fistula after esophageal carcinomaoperation[J].Medical innovation of china,2010,7:18-20
[11]魏祥志,张科,汪永和,等.贲门癌、食管癌术后早期肠内营养应用的体会[J].中国现代医生,2011,49(31):139-141Wei Xiang-zhi,Zhang Ke,Wang Yong-he,et al.The Application ofEarly Enteral Nutrition Treatment in Postoperative Patients withEsophageal or Cardiac Cancer[J].China Modern Doctor,2011,49(31):139-141
[12]霍前伦,黄和平.早期肠内营养对食管癌患者术后的影响[J].中国临床实用医学,2009,3(3):39-40Huo Qian-lun,Huang He-ping.The Influence on Nutrition Supportthrough Duodenal Nutrition Tube after Operation for Patients withEsophageal Carcinoma[J].China clinical practical medicine,2009,3(3):39-40
[13]周勇,魏静义,王文公,等.胃大部切除术后贲门癌及食管癌25例外科治疗[J].临床外科杂志,2010,18(2):111-112Zhou Yong,Wei Jing-yi,Wang Wen-gong,et al.Surgical treatmentfor carcinoma of gastric cardia and esophagus after subtotal gastrectomy:treatment experience of 25 cases[J].Journal of clinical surgery,2010,18(2):111-112
[14]袁培云,袁培江,李献哲,等.食管癌切除胃食管吻合术吻合口瘘及狭窄的预防[J].临床肺科杂志,2008,13(12):1612-1613Yuan Pei-yun,Yuan Pei-jiang,Li Xian-zhe,et al.Prevention of stomachleakage and stricture of esophagogastrtic anastomosis after resectionof esophageal carcinoma[J].Journal of clinical pulmonary medicine,2008,13(12):1612-1613
[15]尹国文,陈世晞,冯纯伟,等.新"三管法"介入治疗胸内食管胃吻合口瘘[J].介入放射学杂志,2008,17(11):812-814Yin Guo-wen,Chen Shi-xi,Feng Chun-wei,et al.The new"3-tube"in terventional therapy for gastroesophageal anastomotic fistula[J].Journal of interventional radiology,2008,17(11):812-814
[16]雷涛,张玲.三管法与两管法治疗胸内食管胃吻合口瘘的对比观察[J].临床外科杂志,2010,18(8):545-547Lei Tao,Zhang Ling.Three-and two-pipe methods for the treatmentof intrathoracic esophagogastric anastomotic fistula[J].Journal ofclinical surgery,2010,18(8):545-547
[17]刘法兵,阮征,郑健,等.胃镜辅助新三管法治疗严重胸内食管胃吻合口瘘[J].临床外科杂志,2011,19(9):622-623Liu Fa-bing,Ruan Zheng,Zheng Jian,et al.Gastroscopy-aided newthree-tube method for treatment of major intrathoracic esophagogas-tric anastomotic leakage[J].Journal of clinical surgery,2011,19(9):622-623
[18]秦永跃,丁旭青,刘国正,等.食管癌术后早期肠内营养的应用体会[J].中国肿瘤外科杂志,2009,1(5):305-306,309Qin Yong-yue,Ding Xu-qing,Liu Guo-zheng,et al.Clinical applica-tion of early enteral nutrition in postoperative esophagus cancer[J].Chinese Journal of surgical oncology,2009,1(5):305-306,309
[19]朱桥华,陈勇,曾庆乐,等.透视下双导丝置管法在食管癌术后吻合口瘘治疗中的应用[J].介入放射学杂志.2008,17:815-817.Zhu Qiao-hua,Chen Yong,Zeng Qing-le,et al.Fluoroscopy guideddouble-guidewire tube placement in treating anastomotic leakage afteresophagectomy for esophageal cancer[J].Journal of interventionalradiology,2008,16:840-841
[20]杨文峰.食管、贲门癌术后X线监视泥鳅导丝引导置入鼻-十二指肠营养管体会[J].肿瘤基础与临床,2009,22(3):245-246Yang Wen-feng.The Analyses of the Loach Guide Wire Placement ofNose-Duodenal Feeding Tube with X-Ray Monitor of EsophagealCancer and Cardiac Cancer Surgeries[J].Journal of basic and clinicaloncology,2009,22(3):245-246