【作者】 魏明；

【导师】 李勇； 王力利；

【作者基本信息】 河北医科大学 ， 外科学， 2011， 硕士

【摘要】 目的:通过收集胃癌住院经手术治疗发生消化道瘘的81例患者临床资料,总结胃癌术后消化道瘘的影响因素及预防措施和诊断、治疗的体会。方法:收集1996.1～2006.12期间在河北医科大学第四附属医院接受治疗的7880例胃部肿瘤患者病例,其中胃癌病例7342例,并收集1996.1至2006.12行手术切除的胃癌患者5702例,未发生消化道瘘患者5621例,发生消化道瘘患者81例,进行研究;患者一般特点及消化道瘘发生相关影响因素:年龄、性别、住院时间(以月为单位)、家族肿瘤史、既往病史及腹部手术史及相关临床资料的收集与登记;胃癌手术治疗情况(手术性质、手术方式及切除部位、胃癌手术消化道重建方式),瘘临床表现及诊断:临床表现为术后发热、腹膜炎体征、引流管引流出浑浊液体、影像学检查证实。消化道瘘的治疗情况。建立我院1996年1月-2006年12月共收治后行胃癌切除术的5702例胃癌手术病人数据库,整理临床资料,应用SPSS18.0程序对数据进行统计分析,分析术后发生81例消化道瘘的临床资料。结果:消化道瘘发生率为1.42%;胃癌合并糖尿病患者共计149例,其中发生消化道瘘9例,发生率为6.04%,对照组消化道瘘发生率为1.30%,χ~2=23.32 P=0.00002;患者术前贫血(男性:血红蛋白<120g/L,女性:血红蛋白<110g/L)为1520例,发生消化道瘘32例,发生率为2.11%,χ~2=6.94 P=0.008;患者术前白蛋白低于30g/L患者为218例,发生消化道瘘为9例,发生率为4.13%,对照组消化道瘘发生率为1.31%,χ~2=11.87 P =0.0006。胃癌合并联合脏器切除患者有18例发生消化道瘘,发生率为5.31%。62例消化道瘘的患者经保守治疗后53例愈合,9例死亡;19例经手术治疗全部愈合,行手术治疗的患者有1例行膈下切开引流术,16例行空肠造瘘术,2例行吻合口切除再次吻合术。结论:胃癌术后消化道瘘是腹部外科常较严重的术后并发症。本研究发现性别、年龄、胃癌合并有心肺疾病、胃癌术前有过腹部手术史与消化道瘘发生没有关系。患者术前贫血发生消化道瘘的发生率为2.11%,患者术前白蛋白低于30g/L,发生消化道瘘的发生率为4.13%,消化道瘘的发生与术前贫血和低蛋白血症有关,术前应纠正贫血以及营养不良等影响因素,降低消化道瘘的发生率。胃癌合并糖尿病患者消化道瘘发生率为6.04%,治疗胃癌的同时应该对糖尿病进行治疗,降低消化道瘘发生的风险。术中对于不同位置、大小的胃癌患者应采用合理的治疗方案,选择合适的吻合方式。保持引流的通畅,合理应用肠外及肠内营养制剂、抗生素,预防感染以及改善患者营养状态,并采取正确措施可以促进消化道瘘的愈合,降低消化道瘘的发生率。更多还原

【Abstract】 Objective : To summarize the influencing factors and preventive measures of Gastrointestinal leakage after gastric cancer, we collected 5702 cases who were diagnosed with gastric cancers operation and underwent operations within 11 years.Methods:5702 individuals, who were admitted to the Fourth of Hebei Medical University for treatment of gastric cancer and received operations from January 1996 to December 2006 were recruited for this study, and the patients who had undergone the laparotomy, thoracotomy or short-circuit operations were excluded. The diagnostic criteria for Gastrointestinal leakage includes clinical manifestations of postoperative fever, signs of peritonitis, turbid draining liquid, and confirmed imaging tests. Data base of the 5,702 individuals was set up, and 81 of them with the compication of Gastrointestinal leakage were specially analyzed. These statistical analyses were performed with a computer software program for Microsoft Windows(SPSS,18.0),and statistical significance was set at P<0.05.Results:The incidence rate of Gastrointestinal leakage was 1.44% in the gastric cancer group, 6.04% in the gastric cancer-with-diabetes group, and 1.30% in the control group. The difference between the different groups was considered to be significant(χ~2=23.32,P=0.00002). The incidence rate of Gastrointestinal leakage was 2.11% in the gastric cancer-with-anemia group,while 1.17% in the control group. The difference between these two groups was considered to be significant (χ~2=6.94,P=0.008). The incidence rate of Gastrointestinal leakage was 4.13% in the gastric cancer-with-hypoproteinemia group,while 1.31% in the control group. The difference between these two groups was also considered to be significant(χ~2=11.87 , P=0.0006).Among all the cases,18 cases with multivisceral excisions finally presented Gastrointestinal leakage(5.31%).It was reported that the high incidence rate of Gastrointestinal leakage was possibly caused by the large tumors which had invaded peripheral organs. Imaging tests are the main methods to examine the leakage.Conclusion: Gastrointestinal leakage is one of the serious complications after gastric cancer which is commonly seen in the field of gastric surgery. It has been clarified that the incidence of Gastrointestinal leakage is correlated with many pre-existing complications like anemia, hypoproteinemia, diabetes ,and so on. Therefore, it is necessary to improve patients’conditions before carrying out operations to reduce the risk of getting Gastrointestinal leakage. In addition, suitable and timely therapeutic measures can decrease the incidence of Gastrointestinal leakage and thus promote the healing of it.更多还原