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Objective:To summarize the experience of surgical methods without repairing the fistula for 92 cases with gastrointestinal intrathoracic fistula.Methods:The surgical methods without repairing the fistula were performed through VATS, small incision assisted with VATS or thoracotomy. The focus of the surgery was to promote lung expansion, eliminate the residual cavity of chest cavity and keep effective drainage. After entering the chest cavity from the affected side, wash chest cavity with a large amount of warm normal saline and sterilize intermittently with iodophor to ensure the sterile environment in the pus cavity. Then completely remove the pleural cellulose or fiberboard on visceral pleura to promote lung expansion, eliminate the residual cavity of the chest cavity. The fistula was covered tightly and supported firmly by the visceral pleura on the lung. Multiple T-tubes were placed in thoracic cavity and fistula to keep effective postoperative drainage.Results:Among 92 cases, 85 cases were cured and the cure rate was 92.4% (85/92).7 cases died and the mortality rate was 7.61% (7/92). The 7 dead cases include 5 cases with esophagogastric anastomotic fistula (the death of 3 cases was cause by aortic esophagogastric fistula, the death of 1 case was cause by thoracic gastric tracheal fistula and 1 case was dead because of pulmonary infection and respiratory failure), 1 case with esophageal rupture (the cause of death was septic shock ), and 1 case with esophageal perforation(the cause of death was pulmonary infection and respiratory failure).Conclusion:Most of the surgeries without repairing gastrointestinal intrathoracic fistula are conducted simply through VATS or small incision assisted with VATS., which is safe and effective.
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Objective:To investigate the predictive effect of postoperative blood lipid metabolism and C-reactive protein/albumin ratio (CAR) on anastomotic fistula after radical resection of esophageal cancer.Methods:A retrospective case-control study was conducted on 256 patients with esophageal squamous cell carcinoma (all aged >50 years) who underwent radical esophagectomy in the thoracic surgery of the Second Affiliated Hospital of Zhengzhou University from January 2017 to December 2020. Total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C), ratio of C-reactive protein to albumin (CAR) and hemoglobin test index were collected. According to whether there was anastomotic fistula after operation, the patients were divided into anastomotic fistula group and non-anastomotic fistula group. The measurement data of normal distribution were compared by t-test, the measurement data of non-normal distribution were expressed by M( Q 1, Q 3), the comparison between groups was expressed by Mann-Whitney U test, and the counting data were expressed by (case(%)).The comparison between groups was performed by χ 2 test. Logistic regression model was used for multivariate analysis. ROC curve and Kappa value were used to evaluate the predictive value of total cholesterol and CAR in postoperative anastomotic fistula. Results:The preoperative body mass index (BMI) ((18.71±1.90) kg/m 2) in anastomotic fistula group was higher than that in non-anastomotic fistula group ((20.59±2.88) kg/m 2), and the difference was statistically significant ( t=3.48, P=0.001). The postoperative total cholesterol ((5.44±1.09) mmol/L), LDL-C ((3.82±1.15) mmol/L) and CAR(0.64(0.41, 0.95)) in anastomotic fistula group were higher than those in non-anastomotic fistula group ((4.54±0.94) mmol/L, (2.92±0.76) mmol/L, 0.27(0.13,0.45)). There were significant differences between the two groups (the statistical values were t=4.84, t=5.69, Z=5.16, all P<0.001)). The hemoglobin concentration of 103.20 (84.94,110.48) g/L was lower than that of non anastomotic fistula group (107.68 (99.20,125.20) g/L), the difference was statistically significant ( Z=2.82, P=0.005). Lower BMI( OR=0.652,95% CI 0.482-0.882), higher total cholesterol( OR=3.240,95% CI 1.430-7.340), lower hemoglobin ( OR=0.837,95% CI 0.777-0.902) and higher CAR( OR=2.161,95% CI 1.597-2.925) were the risk factors of anastomotic fistula in esophageal squamous cell carcinoma( P values were 0.006, 0.005, <0.001 and <0.001,respectively). ROC curve analysis showed that the areas under the curve of total cholesterol and CAR were 0.742 (95% CI:0.643-0.841, P<0.001) and 0.790 (95% CI:0.690-0.890, P<0.001) respectively. The cutoff values were 4.915 mmol/L and 0.605, the sensitivity were 80.0% and 80.0%, the specificity were 82.3% and 92.5%, respectively, and the Kappa values were 0.418 and 0.625 respectively (all P<0.001). Conclusion:Total cholesterol and CAR after radical resection of esophageal cancer have a certain predictive value for postoperative anastomotic fistula in patients with esophageal squamous cell carcinoma. The predictive result of CAR is better than that of total cholesterol.
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ABSTRACT Introduction: Anastomotic leakage is a complication of intestinal anastomosis, with an incidence of 2%-7% in centers of experience. To be able to achieve an early detection, serological markers such as Procalcitonin were included. Methods: Descriptive retrospective cohort study of patients taken to colorectal surgery with intestinal anastomosis, the objective is to estimate association between procalcitonin (≥2 ng/dl) as an early inflammatory marker and anastomotic leakage in a Coloproctological Service of a highest level of health care hospital, between September 2017 and January 2019. Results: Cohort of 237 patients, 51% women (18-89 years), with multiple comorbidities in 81% of patients, colon cancer was the most operated pathology (53.1%). Laparoscopic approach was the most applied 60.34%, colorectal anastomosis was the most frequently performed (47.26%). Ileocolic anastomosis presented a higher frequency (43.75%-n:7) of dehiscence. Anastomotic leakage was associated with a serum procalcitonin positive 3 days postoperatively (p-value <0.05). Patients with a positive result had 4.28 times higher risk of presenting an anastomotic leak, compared to this risk in those patients with negative results 3 days postoperatively, this association was statistically significant 95% CI (1.34-14.16); p value <0.05. Conclusion: Anastomotic leakage is a source of morbidity in patients taken to intestinal anastomosis. It's necessary to guarantee an early diagnosis of this complication, prevent abscesses and secondary peritonitis, providing adequate treatment and even reducing the associated mortality. We recommend including the procalcitonin in the assessment protocol on the third day of postoperative follow-up.
RESUMO Introdução: O vazamento anastomótico é uma complicação da anastomose intestinal, com uma incidência de 2% a 7% em centros com experiência. Para conseguir uma detecção precoce, foram incluídos marcadores sorológicos como a Procalcitonina. Métodos: Estudo de coorte descritivo e retrospectivo de pacientes submetidos à cirurgia colorretal com anastomose intestinal, cujo objetivo é estimar a associação entre os níveis de procalcitonina (≥ 2 ng/dL) como marcador inflamatório precoce e vazamento anastomótico em um Serviço de Coloproctologia de alto nível de atenção à saúde hospitalar, entre setembro de 2017 a janeiro de 2019. Resultados: Coorte de 237 pacientes, 51% mulheres (18−9 anos), com múltiplas comorbidades em 81% dos pacientes, sendo o câncer de cólon a patologia mais operada (53,1%). A abordagem laparoscópica foi a mais utilizada, em 60,34%, e a anastomose colorretal foi a mais frequentemente realizada (47,26%). A anastomose ileocólica apresentou a maior frequência (43,75%, n = 7) de deiscências. O vazamento anastomótico foi associado a procalcitonina sérica positiva 3 dias após a cirurgia (p < 0,05). Pacientes com resultado positivo tinham um risco 4,28 vezes maior de apresentar vazamento anastomótico, em comparação com esse mesmo risco nos pacientes com resultado negativo 3 dias após a cirurgia, sendo essa associação estatisticamente significativa, (IC95%:1,34−14,16); p < 0,05. Conclusão: O vazamento anastomótico é fonte de morbidade em pacientes encaminhados para anastomose intestinal. É necessário garantir o diagnóstico precoce desta complicação, prevenir abscessos e peritonites secundárias, proporcionando tratamento adequado e até mesmo reduzindo a mortalidade associada. Recomendamos incluir a procalcitonina no protocolo de avaliação no terceiro dia de seguimento pós-operatório.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Colorectal Surgery/statistics & numerical data , Early Diagnosis , Anastomotic Leak/diagnosis , Procalcitonin/bloodABSTRACT
Objective To evaluate the surgical efficacy of end-to-end layered anastomosis for patients with esophagogastrostomy after esophagectomy.Methods Selected 35 patients who received end-to-end layered anastomosis in esophagogastrostomy after esophagectomy in people' s hospital of Meishan from January 2016 to February 2017 as end-to-end group,while 21 patients with end-to-side layered anastomosis in esophagogastrostomy after esophagectomy as end-to-side group.The anastomosis time,anastomosis tension,oppression degree,fistula incidence,acid reflux incidence,belching incidence and obstruction incidence between two groups were compared.Results The average anastomosis time was (25.17 ± 5.15)minutes in end-to-end group,and (26.10 ± 5.30)minutes in end-to-side group,the difference was not significant (P ＞ 0.05).The anastomosis tension of end-to-end group,without oppression,was mostly smaller than that of end-to-side group.There were no case of anastomotic fistula in end-to-end group and 2 cases(14.29％) of anastomotic fistula in end-to-side group,the difference was not significant (P ＞ 0.05).There were no case of obstruction in end-to-end group and 4 cases (19.05％) of obstruction in end-to-side group,the difference was significant (P =0.016).There was no significant difference in acid reflux and belching between the two groups (P ＞ 0.05) in perioperative period and 6 months after surgery.There was no delayed anastomotic fistula and anastomotic stenosis needing expansion in 6 months after surgery.Conclusion Without causing more adverse reactions,end-to-end layered anastomosis in esophagogastrostomy after esophagectomy can avoid the incision that may affect the blood supply of esophagus and stomach,and avoid the pressure from esophagus and stomach.
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Objective To understand the distribution and drug resistance of pathogens from patients with anastomotic fistula infection after esophageal cancer surgery, and provide basis for clinical diagnosis and treatment.Methods Patients were admitted to a hospital due to anastomotic fistula after esophageal cancer surgery between January 2012 and December 2015, microbial culture and antimicrobial susceptibility testing results of patients were retrospectively analyzed.Results 1 986 patients underwent radical resection of esophageal cancer within 4 years, 148 of whom developed anastomotic fistula, 104 (70.27％) were with positive microbial culture.A total of 197 pathogenic strains were isolated, 52(26.40％)and 145 (73.60％)strains were isolated from intrathoracic anastomotic fistula and cervical anastomotic fistula respectively;127 (64.47％)strains were gram-negative bacteria, the major were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii, 62(31.47％) strains were gram-positive bacteria, the major were Staphylococcus aureus, Enterococcus spp., and Streptococcus viridans, 8 strains (4.06％) were fungi.49(47.12％) cases were with mixed pathogenic infection.The resistance rates of gram-negative bacteria to imipenem were 17.86％-47.62％, to polymyxin B was 0, resistance rates of Pseudomonas aeruginosa to other antimicrobial agents were all70％, Acinetobacter baumannii to most antimicrobial agents were all>50.00％;resistance rates of gram-positive bacteria to clindamycin and tetracycline were both>50.00％, to linezolid, vancomycin, and teicoplanin were all 0, resistance rates of Staphylococcus aureus to penicillin, oxacillin, and ciprofloxacin were all>60％,resistance rate of Enterococcus spp.to quinupristin/dalfopristin was 100.00％.Conclusion Postoperative anastomotic fistula combined with infection can affect the prognosis of patients after esophageal cancer surgery, regular monitoring on distribution and drug resistance of pathogens can provide the basis for initial empirical treatment, and is conducive to the early treatment and rational use of antimicrobial agents.
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Objective To investigate the risk factors of cervical esophagogastric anastomotic fistula after esophagectomy of esophageal cancer.Methods The retrospective case-control study was conducted.The clinicopathological data of 956 patients who underwent esophagectomy and cervical esophagogastrostomy from January 2012 to December 2016 in the First Affiliated Hospital of Zhengzhou University were collected.Patients underwent Sweet or Mckeown surgery.Observation indicators:(1) intra-and post-operative situations;(2) the risk factors analysis of cervical esophagogastric anastomotic fistula after esophagectomy;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the esophagogastric anastomotic stenosis of patients up to February 2017.Measurement data with normal distribution were represented as the (x)±-s.Univariate analysis and comparison of count data were done using the chi-square test or Fisher exact probability method.Multivariate analysis was done using the Logistic regression model.Results (1) Intra-and post-operative situations:all the 956 patients underwent successful operations,including 107 with Sweet operation and 849 with Mckeown operation.Of 956 patients,336 received thoracotomy and 620 received thoracoscopic surgery.Tumors located in upper,middle and lower esophagus were respectively detected in 143,627 and 186 patients.Operation time,volume of intraoperative blood loss and number of lymph node dissected in 956 patients were (274 ± 67) minutes,(210 ± 167) mL and 18 ± 11,respectively.Of 956 patients,117 had cervical esophagogastric anastomotic fistula,with an incidence of anastomotic fistula of 12.24％ (117/956).Of 117 patients with cervical esophagogastric anastomotic fistula,2 had early stage fistula,110 had middle stage fistula and 5 had later stage fistula;12 were cured by two-tube method (stomach tube and nutrition tube),24 were cured by three-tube method (stomach tube,nutrition tube and chest tube or mediastinal tube),43 were cured by open neck incision dressing,15 were cured by fistula cavity drainage and 17 were cured by esophageal stent implantation.Sixteen patients died in hospital postoperatively,including 6 with cervical esophagogastric anastomotic fistula and 10 without cervical esophagogastric anastomotic fistula.Duration of hospital stay of 956 patients was (16± 11)days,and durations of hospital stay of patients with and without cervical esophagogastric anastomotic fistula were (39± 19) days and (13±6) days.Postoperative pathological examinations:873,9 and 74 patients were respectively diagnosed with squamous cell carcinoma,adenocarcinoma and other types of cancer.TNM staging:stage 0,Ⅰ,Ⅱ,Ⅲ,Ⅳ and unidentified stage were respectively detected in 135,110,325,376,1 and 10 patients.(2) The risk factors analysis of cervical esophagogastric anastomotic fistula after esophagectomy:univariate analysis showed that gender,age,history of diabetes,surgical method,tubular stomach production,operation time,postoperative pulmonary infection and postoperative aspirating sputum through fiberbronchoscope were risk factors affecting cervical esophagogastric anastomotic fistula after esophagectomy,with statistically significant differences (x2 =4.179,6.174,4.427,4.377,6.266,7.057,55.036,51.806,P＜ 0.05).Multivariate analysis showed that tubular stomach production,postoperative pulmonary infection and aspirating sputum through fiberbronchoscope were independent risk factors affecting cervical esophagogastric anastomotic fistula after esophagectomy,with statistically significant differences (OR =1.922,2.907,2.323,95％ confidence interval:l.203-3.070,1.682-5.023,1.235-4.370,P＜0.05).(3) Follow-up situations:908 of 956 patients were followed up for 2-62 months,with a median follow-up time of 28 months.During the follow up,21 of 111 patients with cervical esophagogastric anastomotic fistula were complicated with cervical esophagogastric anastomotic stenosis,59 of 797 patients without cervical esophagogastric anastomotic fistula were complicated with cervical esophagogastric anastomotic stenosis,showing a statistically significant difference in cervical esophagogastric anastomotic stenosis (x2-16.803,P＜0.05).Conclusion Tubular stomach production,postoperative pulmonary infection,postoperative aspirating sputum through fiberbronchoscope are independent risk factors affecting cervical esophagogastric anastomotic fistula after esophagectomy.
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Objective To evaluate the clinical feasibility of performing the placement of drainage tube via transnasal route in treating mediastinal anastomotic fistula after surgery of esophageal cancer.Methods A total of 6 patients with mediastinal anastomotic fistula after surgery of esophageal cancer,who were admitted to authors' hospital during the period from August 2015 to January 2016,were included in this study.The diagnosis was confirmed by esophageal radiography and thoracic CT scan in all the 6 patients.Under X-ray monitoring,the drainage tube was inserted into the cavity of mediastinal fistula with the help of a guide wire guidance,and continuous negative pressure suction was adopted.The jejunum nutrition tube was inserted via the same nostril if feeding tube was not placed.Results Successful placement of fistula drainage tube and jejunum nutrition tube was achieved in all the 6 patients.In one patient the fistula drainage tube had to be re-placed as the drainage tube was obstructed five days after initial placement.Under X-ray monitoring the mean time used for the drainage tube placement was 33 min (range of 23-48 min).The procedure was well tolerated by all the 6 patients,and no procedure-related complications occurred.After continuous negative pressure suction that lasted for 6-40 days (mean of 23 days) the fistulae healed.Conclusion For the treatment of mediastinal anastomotic fistula after surgery of esophageal cancer,the placement of fistula drainage tube under X-ray monitoring is simple,safe and effective.(J Intervent Radiol,2017,26:250-252)
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Objective To explore the impact of using large dose norepinephrine on the anastomotic healing after esophagectomy.Methods Clinical data of data of 148 cases patients with esophageal cancer who were treated in Wuwei Tumor Hospital of Gansu Province with surgery from January 2014 to June 2016 were retrospectively analized.There were 7 patients who were used 25-67 mg ((32.6 ± 2.3) mg) norepinephrine because of the low blood pressure and other factors during the first 4 d postoperative as research group,and the other 141 patients who had not applied or applied the small dose were set as control group.The patients of two groups with postoperative anastomotic healing and fistula incidence were compared.Results There were 3 cases and 7 cases of postoperative patients appeared anastomotic fistula in the research group and the control group,the rate of anastomotic fistula were 42.86％ (3/7) and 4.96％ (7/141) respectively,the difference was significant (x2=9.78,P =0.001),and 2 cases appeared varying degrees residual gastric necrosis in the research group,all of them occurred in the patients with large dosage and long time.Conclusion There are great risk on the anastomotic fistula and residual stomach mecrosis if long time and large dose norepinephrine was used after esophagectomy,it should be caused enough attention for surgeons.
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Objective To investigate the cause of postoperative colorectal cancer anastomotic fistula,the treatment and prevention measures.Methods 2007 -2014,The department of General surgery in Qingdao Municipal hospitals for abdominal colorectal cancer resection(Dixon surgery)were 208 cases,including 13 cases of anastomotic leakage occurred.Retrospective summarized the cause,treatment and preventive measures of abdominal colorectal cancer anastomotic fistula.Results All of 13 patients were discharged,and had no adhesions obstruction,anastomotic stricture,pelvic abscess and other symptoms following -up 6 months after discharge.Conclusion Grasping preopera-tive risk factors of abdominal colorectal cancer for anastomotic fistula,actively preoperative preparation,and master of fine anatomical and surgical point are the main points of the prevention of anastomotic leakage.
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Objective To observe the influence of early postoperative feeding in the healing of intestinal anastomosis in rabbits,and to clarify preliminarily the relationships between early postoperative feeding after gastrointestinal surgery and gastrointestinal anastomotic fistula formation and healing time in rabbits.Methods 48 rabbits were randomly divided into experimental group and control group, then they were treated with gastrointestinal anastomosis.The rabbits in experimental group were fed with liquid diet 24 h after operation,and the rabbits in control group were fed nothing after operation and supplied by total parenteral nutrition.Two rabbits of each group were selected for exploratory laparotomy on the 3rd,5th,7th,10th and 15th day after operation,and the healing rate of anastomosis,the anastomotic bursting pressure,the anastomotic breaking strength,and the hychoxyproline level of anastomosis were observed.Results The healing rate of anastomosis in control group was 91.6%(22/24), and the healing rate of anastomosis in experimental group was 95.8%(23/24),there was no significant difference between two groups(P>0.05).The anastomotic bursting pressures of the rabbits in two groups were decreased remarkably at the 72nd hour after operation,which was the lowest point,and they were increased remarkably on the 5th day after operation,but the anastomic bursting pressure in experimental group was a little lower than that in control group,and it reached the peak on the 7th day after operation in control group. On the 10th day after operation,the anastomic bursting pressure in control group was a little lower than that on the 7th day after operation,but the anastomic bursting pressure in experimental group reached the peak.There were no significant differences of anastomic bursting pressure at different time points between two groups(P>0.05).The anastomotic breaking strength had no significant difference between two groups at the 72nd hour after operation,both of them reached the lowest points,however the anastomtic breaking strengths in two groups were increased remarkably on the 10th day after operation,and reached the peaks.but there were no significant differences of anastomic breaking strength at different time points between two groups (P>0.05 ). The hychoxyproline level of anastomosis:in experimental group was a little lower than that in control group at the 72tnd hour after operation,and both of them reached the peaks on the 7th day after operation;but there were no significant differences of hychoxyproline levels of anastomosis at different time points between two groups(P>0.05).Conclusion Early postoperative feeding can not cause the increase of anasmotic healing time and the incidence rate of gastrointestinal anastomotic fistula.
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Surgical therapy should be the main method in treatment of rectal cancer.Along with the increase rate of undergoing anterior resection for rectal cancer,it is getting be paid more and more attention on postoperative anastomotic fistula as the main complications of rectal carcinoma.In recent research,anastomotic fistula occurred caused by various factors had also been put forward gradually,while the risk factors for postoperative anastomotic fistula were still remain unclear.Therefore,it is very important to understanding the risk factors in order to prevent the happening of the anastomotic fistula,and provide clinical basis for their necessary preventive colostomy.
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Objective To investigate the clinical effects of pedicled omentum covering the intestinal anastomotic stoma in preventing anastomotic fistula.Methods The clinical data of 133 patients with high risk of intestinal anastomotic stoma who were admitted to the Henan Tumor Hospital from May 2009 to May 2012 were retrospectively analyzed.All patients were divided into the improvement group (69 patients) and the control group (64 patients) according to whether the anastomotic stoma was covered by pedicled omentum.All the operations were done by the surgeons in the same group,and the intestinal reconstruction was done by the equipment produced by the same company.All the patients with intestinal tumors received radical resection.The clinical data of the patients in the 2 groups were reviewed and the therapeutic effects of the 2 approaches were compared.All data were analyzed using the chi-square test.Results Three (4.3％) patients had intestinal fistula in the improvement group,including 1 had small bowel anastomotic fistula,1 had small bowel and colonic anastomotic fistula,1 had colonic anastomotic fistula.Eight (12.5％) patients in the control group had intestinal anastomotic fistula,including 1 had duodenal anastomotic fistula,2 had small bowel anastomotic fistula,2 had small bowel and colonic anastomotic fistula,and 3 had colonic anastomotic fistula.There was a significant difference in the incidence of anastomotic fistula between the 2 groups (x2 =5.483,P ＜ 0.05).The highest body temperatures of the 3 patients in the improvement group were under 38.2 ℃,and the mean white blood cell count was 8.4 × 109/L;no peritonitis was detected; turbid drainage was observed in the peritoneal tube around the anastomotic stoma.The results of computed tomography showed local inflammation.The highest body temperatures of the 8 patients in the control group were above 38.5 ℃,and the mean white blood cell count was 14.4 × 109/L; obvious pressing pain and rebound tenderness were detected; intestinal contents were observed in the peritoneal drainage tube.The 3 patients in the improvement group were cured by symptomatic treatment.Of the 8 patients in the control group,7 received two-stage debridement,and 1 received jejunostomy and 3 received ileostomy.The condition of the 7 patients was recovered after operation,and reversion of the ileum at postoperative month 4.One patient died of multiple organs dysfunction syndrome and systemic inflammatory response syndrome.Conclusion Intestinal anastomotic stoma covered by pedicled omentum could effectively decrease the incidence of anastomotic fistula and alleviate systemic inflammatory response syndrome caused by anastomotic fistula.
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Pancreaticoduodenal anastomotic dehiscence complicated with peritoneal hemorrhage following pancreaticoduodenectomy is a serious complication which threatens patients'life.Prevention and mangement of pancreaticoduodenal anastomotic dehiscence and peritoneal hemorrhage is the focus in the surgical treatment.Operation is the most reliable treatment for bleeding.While reoperation is difficult for most surgeons and the risk of fistula and rebleeding after reoperation exist.Some procedures will affect the endocrine and exocrine function of pancreas.We applied pancreaticojejunal bridge drainage for most patients with hemorrhage after pancreaticoduodenectomy.This procedure is easy,safe,and can protect the pancreatic function.
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Objective To explore the safety and clinical efficacy of the purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis.Methods The clinical data of 238 patients with thoracic esophageal carcinoma and 24 patients with carcinoma of the esophagogastric junction received intrathoracic apparatus anastomosis at the Sichuan Provincial People's Hospital from January 2008 to December 2011 were retrospectively analyzed.There were 122 patients received conventional intrathoracic esophagogastric anastomosis (conventional group) and 140 patients received purse string suture stitched in gastric wall of anastomotic stoma before intrathoracic esophagogastric anastomosis (improvement group).The incidences of anastomotic fistula and stenosis of the 2 groups were compared.All data were anlayzed using the t test,chisquare test or Fisher exact probability.Results There were no significant differences in the operation time,intraoperative blood loss,volume of drainage of peritoneal effusion within 24 hours after operation,postoperative hospital stay and postoperative pTNM staging between the 2 groups (t =0.410,0.798,0.634,0.362,x2=0.605,P ＞ 0.05).There were no significant differences in the anastomotic location,stapler type,the weight of stapler esophageal end tissue between the 2 groups (x2 =0.118,0.221,t =0.459,P ＞ 0.05).There were no significant differences in the incidences of pulmonary complication,arrhythmia and mortality between the 2 groups (P ＞ 0.05).The weight of stapler stomach end tissue in the improvement group was significantly greater than that of the conventional group,while the incidences of postoperative anastomotic fistula and stenosis of the improvement group were significantly lower than those of the conventional group (t =13.856,P ＜ 0.05).Conclusion The purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis is simple and safe,and could effectively reduce the rate of anastomotic fistula and stenosis.
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Objective To explore the cause of anastomotie fistula after esophagus cancer and cardiac cancer operation and its prevention and treatment.Methods After excising the tumors,the esophagogastrostomy was performed in 60 cases,in which the cervical anastomose in 48 cases and intrathoracic anastomose was adopted in 12 cases.We retrospectively analyzed its prevention and treatment. Results Caevial anastomose in 48 cases,4 patients with anastomotic fistula in the died,while none of 12 cases in the cervical anastomose died. Conclusions Careful procedure and improving the anastomotic methods are the key factors to reduse the anastomotic fistula,the accurate control of infection and full nutritive support are the effective methods to decrease the mortality rate of this disease.
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OBJECTIVE To investigate the cause,diagnosis and treatment of the empyema of the anastomotic fistula after esophageal cancer resection.METHODS The clinical data of 624 cases after esophageal cancer and cardia cancer resection from Jan 2000 to Dec 2006 were analyzed retrospectively which included 14 cases of the empyema of the anastomotic fistula.RESULTS All the cases were treated with the closed thoracic drainage,in which 9 cases were cured with closing double-tube chest douching technique,3 cases were succeeded to operate secondary thoracotomy for anastomosis,1 case died after being sent to the higher grade hospital,1 case died for toxic shock and respiratory failure without the chance of reoperation.CONCLUSIONS The key measures of prevention of empyema of post-operative esophagogastrostomy anastomotic fistula inside thorax are strictly distincting between indication and contraindication,carefully preparating before operation,commanding operative time and technical skill,strengthening nursing management,and fulfilling the oral manipulation and nursing prcedures about the drainage tube after operation.
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Objective To investigate the cause and diagnosis of anastomotic fistula following low anterior excision of rectal cancer,and its management and prevention measures.Methods Retrospectively analyzed the clinical data of 6 patients with anastomotic leakage underwent anterior excision of rectal cancer.Results 115 patients accepted anterior excision of rectal cancer,6 patients developed anastomotic fistula.5 patients are cured with effective pelvic drainage and 1 case with ileostomy and pelvic drainage.Conclusions Anastomotic fistula is one of the most serious complications related to pre-operative preparation,blood supply and anastomotic tension,intra-operative technigues and effective of drainage.It can be avoided or reduced by different prophylactic measures.