Adegboye V O, Brimmo I A, Adebo O A, Osinowo O
Department of Surgery, University College Hospital, Ibadan, Nigeria.
Afr J Med Med Sci. 2002 Mar;31(1):5-8.
Over a period of 8 years, 15 of the 65 patients who had transhiatal esophagectomy (THE) for esophageal diseases and cervical esophagogastrostomy had cervical oesophagogastric anastomotic leak. Seven of the 18 patients (38.9%) with corrosive esophageal strictures (CES) due to acid burns had anastomotic leaks while 2 out of 6 patients (33.3%) and 6 out of 41 patients (14.6%) were the incidences of anastomotic leaks among alkali burnt and carcinoma of the esophagus. Anastomotic leaks were more commonly associated with surgery for CES. They were managed by trans-oral irrigation with water after ingestion of either soft/solid diet or high protein, high carbohydrate fluid diet along with adequate jejunostomy feeding. The age of the patients ranged between 5 to 65 years (mean 38.8 +/- 15.7 year). Anastomotic leaks were diagnosed between 3rd to 10th postoperative day (mean 7.1 +/- 2.6 day). The period of transoral irrigation before closure of leakage ranged from 2 to 14 days (mean 6.1 +/- 2.9). In 12 patients (80%) anastomotic leakage closed within 5 days, (mean 3.9 +/- 1.0). Two weeks after closure, all the patients had bouginage and every two weeks for another 3 dilation. Four of the 15 patients needed repeated two monthly dilation for 8 to 12 months. There were no other complications nor mortality in this study. There was psychological acceptance of this minimally invasive procedure.
在8年的时间里，65例因食管疾病接受经胸食管切除术（THE）并行颈部食管胃吻合术的患者中有15例发生颈部食管胃吻合口漏。18例因酸烧伤导致腐蚀性食管狭窄（CES）的患者中有7例（38.9%）发生吻合口漏，而6例碱烧伤患者中有2例（33.3%）、41例食管癌患者中有6例（14.6%）发生吻合口漏。吻合口漏在CES手术中更为常见。在摄入软食/固体食物或高蛋白、高碳水化合物流食并进行充分的空肠造口喂养后，通过经口用水冲洗进行处理。患者年龄在5至65岁之间（平均38.8±15.7岁）。吻合口漏在术后第3至10天被诊断出来（平均7.1±2.6天）。漏口闭合前经口冲洗的时间为2至14天（平均6.1±2.9天）。12例患者（80%）的吻合口漏在5天内闭合（平均3.9±1.0天）。闭合两周后，所有患者均接受探条扩张，之后每两周再进行一次扩张，共3次。15例患者中有4例需要每两个月重复扩张8至12个月。本研究中无其他并发症及死亡病例。患者对这种微创手术在心理上能够接受。
