Fan S T, Lau W Y, Yip W C, Poon G P, Yeung C, Wong K K
Government Surgical Unit, Queen Mary Hospital, Hong Kong.
Surg Gynecol Obstet. 1988 Apr;166(4):307-10.
In a series of 132 patients who had undergone surgical treatment for carcinoma of the esophagus and upper part of the stomach, anastomotic leakage occurred in 29. We retrospectively studied the factors that could influence the healing of the fistulas in the management of this condition. Despite adequate supportive treatment, including total parenteral nutrition, five patients died from unrelenting infection. Fifteen fistulas closed spontaneously after an average of about four weeks of conservative treatment and full nutritional therapy. Those patients who had persistent fistulas after similar treatment were found to have either residual tumor after palliative operation or preoperative serum albumin levels that were lower than those of the other group. Prolonged conservative treatment for persistent fistulas may not be warranted if such risk factors are identified, and surgical repair should be considered.
在一组132例接受过食管癌和胃上部手术治疗的患者中，有29例发生了吻合口漏。我们回顾性研究了在这种情况的处理中可能影响瘘口愈合的因素。尽管采取了充分的支持治疗，包括全胃肠外营养，但仍有5例患者死于难以控制的感染。15例瘘口在平均约四周的保守治疗和充分营养治疗后自行闭合。经类似治疗后仍有持续性瘘口的患者被发现要么是姑息手术后有残留肿瘤，要么术前血清白蛋白水平低于另一组。如果识别出此类危险因素，对于持续性瘘口可能无需进行长时间的保守治疗，而应考虑手术修复。
