胃癌术后消化道瘘的临床研究（附81例病例分析）
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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。
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.
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。
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.
引文
1杜义安,季永领.可手术胃癌综合治疗进展[J].中国肿瘤,2007,16(5):331-334
2 Rolandelli R ,Roslyn JJ . Surgical management and treatment of sepsis associated with gastrointestinal fistulas[J ] . Surg Clin Nor Am ,1996 ,76∶1111-1122
3 Jech B, Felberbauer FX, Herbst F. Complications of elective surgery for rectal cancer[J]. European Surgery,2007,39(1):8-14
4陈峻青,夏志平,主编.胃肠癌根治手术学[M].北京:人民卫生出版社,1998. 96
5 Ping YM, He M, Meng XL.Prevention and treatment of complications after surgical resection for esophageal and gastric cardiac cancers[J]. Zhonghua Yi Xue Za Zhi. 2009,10;89(5):296-300
6佟建秋,付光,何晓宁.老年糖尿病患者腹部手术的围手术期处理[J].中国老年学杂志,2009 ,29(5):597-598
7 Shu X, Ji J, Li X, Cancer risk among patients hospitalized for Type 1 diabetes mellitus: a population-based cohort study in Sweden[J]。Diabet Med. 2010 Jul;27(7):791-797
8 Yoo HK, Serafin BL.Perioperative management of the diabetic patient [J]. Oral Maxillofac Surg Clin North Am. 2006 , 18(2):255-260
9洪强,郑启昌,陈海波.胃癌合并糖尿病的围手术期处理探讨[J].中国现代医学杂志,2005,15(6):880-882
10王定明,梁一举,杨军.28例糖尿病患者胃癌围手术期处理体会[J].现代医药卫生,2006,22(3):341-342
11马建华,王颖,齐绍康.糖尿病病人围手术期危险因素的评估[J].天津医药,1998,26(2):77
12吴永新,金华,木霖.老年糖尿病人围手术期的胰岛素泵治疗[J].中国现代医学杂志,2004,14(8):138,140
13王定明,梁一举,杨军.28例糖尿病患者胃癌围手术期处理体会[J].现代医药卫生,2006,22(3):341-342
14赵峻,张默言,程贵余,等.食管癌、贲门癌合并糖尿病288例的围手术期治疗分析[J].肿瘤学杂志,2010,16(2):127-129
15 Dunne J R ,Malone D, T racyjk ,e t a l .Perioperative anemia:an independent risk factor for infection,mortality,and resource utilization in surgery[J].J Surg Res ,2002,102(2):237-244
16林志强俞武生叶振伟.25例消化道瘘的临床分析[J].岭南现代临床外科,2008,8(3):196-200
17王敏,王欣彦.合并贫血的围术期处理[J].中国实用妇科与产科杂志,2007,23(2):95-98
18 Luna-Pérez P, Rodríguez-Ramírez SE, Gutiérrez de la Barrera M, et al. Multivariate analysis of risk factors associated with dehiscence of colorecta anastomosis after anterior or lower anterior resection for sigmoid or rectal cancer[J]. Rec Invest Clin, 2002,54(6):501-508
19 Kunitake H, Hodin R, Shellito PC, et al.Perioperative treatment with infliximab in patients with Crohn's disease and ulcerative colitis is not associated with an increased rate of postoperative complications[J]. J Gastrointest Surg. 2008,12(10):1730-1737
20李幼生,黎介寿.围手术期肠内营养支持[J].实用临床医药杂志. 2004,8(5):1-5
21鲁鸣,李俊海,张建英,等.前外侧开胸治疗食管下段癌及贲门癌的体会[J].陕西肿瘤医学,2001,9(3),179-179,181
22王生祥,陈文元,米登海,等.贲门癌手术径路选择69例临床分析[J].兰州医学院学报,2004 , 30 (1 ):66-67
23吕英义,陈景寒,孟龙,等.联合脏器切除治疗局部晚期贲门癌37例分析[J].中国实用外科杂志,2005,2(8):479-481
24李经栋,陈业庭,段长华,等.预防食管胃吻合口瘘的措施初探(附连续1 4 6例无死亡无瘘报告)[ J ] .皖南医学院学报,1994,13(2 ):40-41
25梅斌臣.胃肠吻合口瘘的防治[J].中国误诊学志,2007,7(11):2513
26范永田,陈贤贵.胃肠吻合口瘘诊治分析[J].浙江临床医学,2001,3(10):735
27毕连臣,麦威,秦千子,等.肠外瘘并腹腔感染的临床诊治[J].中国普外基础与临床杂志,2009,7(16):573-574
28阳红艳,许乙凯,刘文源,等.腹腔脓肿的CT诊断价值[J].临床放射学杂志,2006,4(25):354-356
29徐德银.食管胃吻合口瘘22例诊治经验[J].安徽医学,2003,24(6):38-39
30 Bodoky G,Harsanyi L,Pap A.Effect of enteral nutrition on exo-crine pancreatic function[J].Am J Surg,1991,161:144-148
1 Jech B, Felberbauer FX, Herbst F. Complications of elective surgery for rectal cancer[J]. European Surgery,2007,39(1):8-14
2 Taggarshe D, Bakston D,Jacobs M, et al. Management of enterocutaneous fistulae: A 10 years experience [J].World J Gastrointest Surg,2010 ,2(7):242-246
3 ManchesterHR. Metabolism of sepsis and multiple organ failure [J]. World of Surgery.1996, 20(1): 460-464
4 Fielding LP, Stewart-Brown S, Blesovsky L,et al. Anastomotic integrity after operations for large-bowel cancer: a multicentre study[J]. Br Med J, 1980, 281(6237): 411-414
5龚太乾,蒋耀光,王如文,等.食管癌术后早期并发症及死亡原因分析[J].中国胸心血管外科临床杂志[J],2005,12(3):173-176
6 Ferenschild FT, Dawson I, de Wilt JH,,et al. Total mesorectal excision for rectal cancer in an unselected population: quality assessment in a low volume center[J]. Int J Colorectal Dis. 2009,24(8): 923-929
7杨桂桥,郑占军,俞林.低位直肠癌吻合器保肛手术临床探讨[J].中华中西医杂志,2009 , 10 (7) ;504-506
8 Dan HL,Bai Y,Meng H,et al.A new three-layer-funnelshapedesophagogastric anastomosis for surgical treatment of esophageal carcinoma[J]. World J Gastroenterol ,2003;9(1):22-25
9朱正奎.吻合器在食管癌、贲门癌手术中的应用体会[J].海军医学杂志.2003,24 (4) :307-308
10 Villanueva-Sáenz E, Sierra-Montenegro E , Rojas-Illanes M ,et al.Double stapler technique in colorectal surgery[J]. Cir Cir. 2008,76(1):49-53
11陆锋,王世伟,刘如南,等.消化道瘘62例临床分析[J].腹部外科.2002,5(1):25-26
12 DreylingM, LenzG, HosterE. Early consolidation bymyeloabla-tive radiochemotherapy followed by autologous stem cell transplan-tation infirst remission significantly prolongs progression-free sur-vival in mantle-cell lymphoma: results of a prospective random-ized trial of the EuropeanMCL Network[J]. Blood, 2005, 105(7): 2677-2684
13 Kunitake H, Hodin R, Shellito PC, et al.Perioperative treatment with infliximab in patients with Crohn's disease and ulcerative colitis is not associated with an increased rate of postoperative complications[J]. J Gastrointest Surg. 2008,12(10):1730-1737
14 Swellengrebel HA, Marijnen CA, Verwaal VJ,et al.Toxicity and complications of preoperative chemoradiotherapy for locally advanced rectal cancer[J]. Br J Surg. 2011,98(3):418-426
15 Wu JH, Rong ZX.Laparoscopic anterior resection of rectal carcinoma with preservation of the left colonic artery[J]. Nan Fang Yi Ke Da Xue Xue Bao.2009,29(6):1249-1250
16徐光辉.直肠癌Dixon术吻合口瘘的防治[J].临床医学,2005,25(5):51-53
17沈建辉.胃大部切除术后消化道瘘的原因和防治[J].苏州医科大学学报,2003,23(3):364-372
18 Kawahara H, Yoshimoto K, Watanabe K,et al. Intraoperative drainage of intestinal contents in emergency surgical treatment of left-sided colonic obstruction[J]. Hepatogastroenterology. 2008 ,55(84):940-942
19 Wilmot AS, Levine MS, Rubesin SE, et al.Intraluminal migration of surgical drains after transhiatal esophagogastrectomy: radiographic findings and clinical relevance[J]. AJR Am J Roentgenol. 2007,189(4):780-785
20 Ikeda S, Takeda H, Yoshimitsu M, et al.Abscess in the inguinal hernial sac after peritonitis surgery: A case report[J]. World J Gastroenterol. 2009,15(8): 1007–1009
21李树怀,杨荣华.老年结直肠癌急性肠梗阻手术治疗分析[J].中国实用医药,2008, 3(29):34-36
22姚珂,闵家新,张国强,等.食管癌贲门癌合并糖尿病的外科治疗[J].中国现代医学杂志,2004,14(19):116-119
23刘铁辉.胃癌合并幽门梗阻的围手术期处理[J].吉林医学,2001,2(2):108
24黎介寿肠外瘘第2版[M]人民军医出版社
25 Brisinda G, Vanella S, Cadeddu F, et al. End-to-end versus end-to-side stapled anastomoses after anterior resection for rectal cancer[J].J Surg Oncol. 2009,99(1):75-79
26 Matsuda T, Kaneda K, Takamatsu M, et al.Reliable preparation of the gastric tube for cervical esophagogastrostomy after esophagectomy for esophageal cancer[J]. Am J Surg. 2010 May;199(5):e61-64
27 DeArmond DT, Cline AM, Johnson SB.Anastomotic leak detection by electrolyte electrical resistance[J]. J Invest Surg. 2010,23(4):197-203
28 Nair A, Pai DR, Jagdish S.Predicting anastomotic disruption after emergent small bowel surgery[J]. Dig Surg. 2006;23(5-6):369
29郑凤群,蔡建荣.食管贲门癌合并糖尿病患者吻合口瘘的治疗体会[J].临床军医杂志,2008,36(2):314-315
30 Sato N, Yamaguchi K, Yokohata K ,et al.Preoperative exocrine pancreatic function predicts risk of leakage of pancreaticojejunostomy[J]. Surgery. 1998 ,124(5):871-876
31赫鹏,白立炜.胃肠道手术后肠外瘘42例临床分析[J].河北医学,2005,8(11):1008-1009
32李兴睿,易继林.大剂量奥曲肽在肠瘘治疗中的应用[J].实用医学杂志,2005,21(5):521-522
33 Reynolds JV,FurrellyC,FeigheryC, eta.l Impaired gutbarrier func-tion inmalnourished patients[J]. Bri.l J. surgery, 1996, 83: 1288-1291
34任建安.肠外瘘并腹腔感染的细菌学与耐药分析[J].外科理论与实践,2001,6:252
35刘志毅刘艳玲.结肠梗阻急性手术中肠道准备的探讨[J].中国现代医学杂志,2003,13(23):137-138
36 Riss S, Stift A, Kienbacher C,et al.Recurrent abscess after primary successful endo-sponge treatment of anastomotic leakage following rectal surgery[J]. World J Gastroenterol. 2010 , 16(36): 4570–4574
37张代成,王世文,康迎新,等.7 1例大肠癌性梗阻急诊I期手术体会[J].兰州医学院学报,2004,3O(l): 41-43
38李伟,王明,王明轩.肠瘘30例的临床治疗[J].中华现代中西医杂志,2005,3(13):1191-1192
39卢正嘉,张志强,许蕾,等.肠瘘的临床分析[J].中外健康文摘,2008,5(24):55-56
40 Walker KG, Bell SW, Rickard MJ, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer[J]. Ann Surgery, 2004,240(2):255-259
41陈刚,谢亮,唐继鸣,等.食管癌术后颈部吻合口纵隔、胸腔内瘘的诊治——附5例报告及文献复习.癌症,2005,24(10):1280-1283
42 Müller-Wille R, Iesalnieks I , Christian Dorniaet,al.Influence of percutaneous abscess drainage on severe postoperative septic complications in patients with Crohn's disease[J]. Int J Colorectal Dis. 2011 ,1(1): [Epub ahead of print]
43 Binneb?sel M, Grommes J.Zinc deficiency impairs wound healing of colon anastomosis in rats[J]. Int J Colorectal Dis. 2010 Feb;25(2):251-257.
44 Pham NV, Cox-Reijven PL, Greve JW,et al, Application of subjective global assessment as a screening tool for malnutrition in surgical patients in Vietnam.Clin Nutr, 2006,25(1):102-108
45 Ghariani B, Houissa H, Sebai F.Early diagnosis of anastomotic dehiscence after colonic surgery[J]. Tunis Med. 2011,89(2):174-178
46邰建东,刘玉石,王广义.直肠癌保肛术后发生吻合口瘘的影响因素及其处理[J].中华胃肠外科杂志,2007,10(2):153-156
47梅斌臣.胃肠吻合口瘘的防治[J].中国误诊学杂志,2007,7(11):2513-2514
48 Doeksen A, Tanis PJ, Wüst AF,et al.Radiological evaluation of colorectal anastomoses[J].Int J Coloectal Dis, 2008 ,23(9):863-868
49窦会敏,赵国营,张俊乐,等,胸内食管胃吻合口瘘的CT诊断[J].临床研究,2007,45(7):48,55
50王寿强.食管癌贲门癌术后胸内吻合口瘘的治疗[J].实用肿瘤杂志,2002,17(5):347-348
51夏海娜,19例高流量消化道瘘引流的观察与处理[J].中原医刊,2005, 32(21):19-20
52张红卫,黎洪浩,王捷.持续腹腔冲洗引流治疗消化道瘘[J].中国实用外科杂志,2007,27(3):237-238
53罗健,黄卫,黄斌.油纱烟卷换药法在消化道瘘治疗中的应用价值[J].西部医学,2010,22(9): 1678-1679
54 Dearlove JL. Skin care management of gastrointestinal fistulas[J]. Surg ClinNorth Am. 1996,76:1095-1110
55 C Cro, K J George, J Donnelly,et al.Vacuum assisted closure system in the management of enterocutaneous fistulae[J]. Postgrad Med J 2002;78:364-365
56林志强,俞武生,叶振伟,等.25例消化道瘘的临床分析[J].岭南现代,临床外科,2008,8(3): 196-197,200.
57李宁,李有信,冯喆.清洁手术预防应用抗生素1∶1病例对照研究[J].中华医院感染杂志.2001,11(4):247-248.
58范书润,杨再珍,冯光强.食管贲门癌术后胸内消化道瘘诊治分析[J].医药论坛杂志,2007,28(13):52
59赵兰华.食管癌术后并发吻合口瘘的观察与护理[J].中华医药杂志,2003,3(1):89
60李群.链霉素局部使用治疗消化道瘘15例[J].基层医学论坛2003,7(4):352
61黎介寿,任建安,王新波,等.生长抑素与生长激素促进肠外瘘自愈的机理与临床研究[J].中华外科杂志,2000,38(6):447-448
62蒋婧.联合用药治疗上消化道瘘病人的护理[J].护理研究,2004 ,18 (9)1643-1645
63刘庆文黄冠群.PN在胃癌术后的临床应用[J].中国民族民间医药,2009,18(6):24-26
64 GouillatC, Chipponi J, Baulieux J, et al. Randomized controlled multicentre trial of somatostatin infusion afterpancreaticoduode-nectomy[J]. Br J Surg, 2001,88(11):1456-1462
65 Bodoky G,Harsanyi L,Pap A.Effect of enteral nutrition on exo-crine pancreatic function[J].Am J Surg,1991,161:144-148
66王琦,李琨,赫杰,等.胃癌切除术后吻合口瘘的营养支持[J].腹部外科,2008,,21(4):220-222
67保红平,杨浩雷,高瑞岗,等.腹部外科手术后肠内营养支持的临床研究[J].中华消化外科杂志,2007,6(1):32-34
68沈建辉.胃大部切除术后消化道瘘的原因和防治[J].苏州大学学报:医学版,2003,23(3):364-364,372
69肖君,张翼,谢虹.食管癌、贲门癌术后吻合口瘘的预防及处理[J].实用预防医学,2007, 14 (6):1869-1870
70陈业庭,杨林,朱青松,等.食管癌、贲门癌术后吻合口瘘的预防[J].世界医学,2006,11(3):32
71徐启明,周乃康,刘曦.食管癌贲门癌切除机械吻合术后胃食管反流的诊断和治疗[J].中国现代医学杂志,2006,16(14):2166-2169,2172
72张时绥.胃大部切除术后近期并发症的防治[J].中国普通外科杂志,1993,2(2)∶93
2 Rolandelli R ,Roslyn JJ . Surgical management and treatment of sepsis associated with gastrointestinal fistulas[J ] . Surg Clin Nor Am ,1996 ,76∶1111-1122
3 Jech B, Felberbauer FX, Herbst F. Complications of elective surgery for rectal cancer[J]. European Surgery,2007,39(1):8-14
4陈峻青,夏志平,主编.胃肠癌根治手术学[M].北京:人民卫生出版社,1998. 96
5 Ping YM, He M, Meng XL.Prevention and treatment of complications after surgical resection for esophageal and gastric cardiac cancers[J]. Zhonghua Yi Xue Za Zhi. 2009,10;89(5):296-300
6佟建秋,付光,何晓宁.老年糖尿病患者腹部手术的围手术期处理[J].中国老年学杂志,2009 ,29(5):597-598
7 Shu X, Ji J, Li X, Cancer risk among patients hospitalized for Type 1 diabetes mellitus: a population-based cohort study in Sweden[J]。Diabet Med. 2010 Jul;27(7):791-797
8 Yoo HK, Serafin BL.Perioperative management of the diabetic patient [J]. Oral Maxillofac Surg Clin North Am. 2006 , 18(2):255-260
9洪强,郑启昌,陈海波.胃癌合并糖尿病的围手术期处理探讨[J].中国现代医学杂志,2005,15(6):880-882
10王定明,梁一举,杨军.28例糖尿病患者胃癌围手术期处理体会[J].现代医药卫生,2006,22(3):341-342
11马建华,王颖,齐绍康.糖尿病病人围手术期危险因素的评估[J].天津医药,1998,26(2):77
12吴永新,金华,木霖.老年糖尿病人围手术期的胰岛素泵治疗[J].中国现代医学杂志,2004,14(8):138,140
13王定明,梁一举,杨军.28例糖尿病患者胃癌围手术期处理体会[J].现代医药卫生,2006,22(3):341-342
14赵峻,张默言,程贵余,等.食管癌、贲门癌合并糖尿病288例的围手术期治疗分析[J].肿瘤学杂志,2010,16(2):127-129
15 Dunne J R ,Malone D, T racyjk ,e t a l .Perioperative anemia:an independent risk factor for infection,mortality,and resource utilization in surgery[J].J Surg Res ,2002,102(2):237-244
16林志强俞武生叶振伟.25例消化道瘘的临床分析[J].岭南现代临床外科,2008,8(3):196-200
17王敏,王欣彦.合并贫血的围术期处理[J].中国实用妇科与产科杂志,2007,23(2):95-98
18 Luna-Pérez P, Rodríguez-Ramírez SE, Gutiérrez de la Barrera M, et al. Multivariate analysis of risk factors associated with dehiscence of colorecta anastomosis after anterior or lower anterior resection for sigmoid or rectal cancer[J]. Rec Invest Clin, 2002,54(6):501-508
19 Kunitake H, Hodin R, Shellito PC, et al.Perioperative treatment with infliximab in patients with Crohn's disease and ulcerative colitis is not associated with an increased rate of postoperative complications[J]. J Gastrointest Surg. 2008,12(10):1730-1737
20李幼生,黎介寿.围手术期肠内营养支持[J].实用临床医药杂志. 2004,8(5):1-5
21鲁鸣,李俊海,张建英,等.前外侧开胸治疗食管下段癌及贲门癌的体会[J].陕西肿瘤医学,2001,9(3),179-179,181
22王生祥,陈文元,米登海,等.贲门癌手术径路选择69例临床分析[J].兰州医学院学报,2004 , 30 (1 ):66-67
23吕英义,陈景寒,孟龙,等.联合脏器切除治疗局部晚期贲门癌37例分析[J].中国实用外科杂志,2005,2(8):479-481
24李经栋,陈业庭,段长华,等.预防食管胃吻合口瘘的措施初探(附连续1 4 6例无死亡无瘘报告)[ J ] .皖南医学院学报,1994,13(2 ):40-41
25梅斌臣.胃肠吻合口瘘的防治[J].中国误诊学志,2007,7(11):2513
26范永田,陈贤贵.胃肠吻合口瘘诊治分析[J].浙江临床医学,2001,3(10):735
27毕连臣,麦威,秦千子,等.肠外瘘并腹腔感染的临床诊治[J].中国普外基础与临床杂志,2009,7(16):573-574
28阳红艳,许乙凯,刘文源,等.腹腔脓肿的CT诊断价值[J].临床放射学杂志,2006,4(25):354-356
29徐德银.食管胃吻合口瘘22例诊治经验[J].安徽医学,2003,24(6):38-39
30 Bodoky G,Harsanyi L,Pap A.Effect of enteral nutrition on exo-crine pancreatic function[J].Am J Surg,1991,161:144-148
1 Jech B, Felberbauer FX, Herbst F. Complications of elective surgery for rectal cancer[J]. European Surgery,2007,39(1):8-14
2 Taggarshe D, Bakston D,Jacobs M, et al. Management of enterocutaneous fistulae: A 10 years experience [J].World J Gastrointest Surg,2010 ,2(7):242-246
3 ManchesterHR. Metabolism of sepsis and multiple organ failure [J]. World of Surgery.1996, 20(1): 460-464
4 Fielding LP, Stewart-Brown S, Blesovsky L,et al. Anastomotic integrity after operations for large-bowel cancer: a multicentre study[J]. Br Med J, 1980, 281(6237): 411-414
5龚太乾,蒋耀光,王如文,等.食管癌术后早期并发症及死亡原因分析[J].中国胸心血管外科临床杂志[J],2005,12(3):173-176
6 Ferenschild FT, Dawson I, de Wilt JH,,et al. Total mesorectal excision for rectal cancer in an unselected population: quality assessment in a low volume center[J]. Int J Colorectal Dis. 2009,24(8): 923-929
7杨桂桥,郑占军,俞林.低位直肠癌吻合器保肛手术临床探讨[J].中华中西医杂志,2009 , 10 (7) ;504-506
8 Dan HL,Bai Y,Meng H,et al.A new three-layer-funnelshapedesophagogastric anastomosis for surgical treatment of esophageal carcinoma[J]. World J Gastroenterol ,2003;9(1):22-25
9朱正奎.吻合器在食管癌、贲门癌手术中的应用体会[J].海军医学杂志.2003,24 (4) :307-308
10 Villanueva-Sáenz E, Sierra-Montenegro E , Rojas-Illanes M ,et al.Double stapler technique in colorectal surgery[J]. Cir Cir. 2008,76(1):49-53
11陆锋,王世伟,刘如南,等.消化道瘘62例临床分析[J].腹部外科.2002,5(1):25-26
12 DreylingM, LenzG, HosterE. Early consolidation bymyeloabla-tive radiochemotherapy followed by autologous stem cell transplan-tation infirst remission significantly prolongs progression-free sur-vival in mantle-cell lymphoma: results of a prospective random-ized trial of the EuropeanMCL Network[J]. Blood, 2005, 105(7): 2677-2684
13 Kunitake H, Hodin R, Shellito PC, et al.Perioperative treatment with infliximab in patients with Crohn's disease and ulcerative colitis is not associated with an increased rate of postoperative complications[J]. J Gastrointest Surg. 2008,12(10):1730-1737
14 Swellengrebel HA, Marijnen CA, Verwaal VJ,et al.Toxicity and complications of preoperative chemoradiotherapy for locally advanced rectal cancer[J]. Br J Surg. 2011,98(3):418-426
15 Wu JH, Rong ZX.Laparoscopic anterior resection of rectal carcinoma with preservation of the left colonic artery[J]. Nan Fang Yi Ke Da Xue Xue Bao.2009,29(6):1249-1250
16徐光辉.直肠癌Dixon术吻合口瘘的防治[J].临床医学,2005,25(5):51-53
17沈建辉.胃大部切除术后消化道瘘的原因和防治[J].苏州医科大学学报,2003,23(3):364-372
18 Kawahara H, Yoshimoto K, Watanabe K,et al. Intraoperative drainage of intestinal contents in emergency surgical treatment of left-sided colonic obstruction[J]. Hepatogastroenterology. 2008 ,55(84):940-942
19 Wilmot AS, Levine MS, Rubesin SE, et al.Intraluminal migration of surgical drains after transhiatal esophagogastrectomy: radiographic findings and clinical relevance[J]. AJR Am J Roentgenol. 2007,189(4):780-785
20 Ikeda S, Takeda H, Yoshimitsu M, et al.Abscess in the inguinal hernial sac after peritonitis surgery: A case report[J]. World J Gastroenterol. 2009,15(8): 1007–1009
21李树怀,杨荣华.老年结直肠癌急性肠梗阻手术治疗分析[J].中国实用医药,2008, 3(29):34-36
22姚珂,闵家新,张国强,等.食管癌贲门癌合并糖尿病的外科治疗[J].中国现代医学杂志,2004,14(19):116-119
23刘铁辉.胃癌合并幽门梗阻的围手术期处理[J].吉林医学,2001,2(2):108
24黎介寿肠外瘘第2版[M]人民军医出版社
25 Brisinda G, Vanella S, Cadeddu F, et al. End-to-end versus end-to-side stapled anastomoses after anterior resection for rectal cancer[J].J Surg Oncol. 2009,99(1):75-79
26 Matsuda T, Kaneda K, Takamatsu M, et al.Reliable preparation of the gastric tube for cervical esophagogastrostomy after esophagectomy for esophageal cancer[J]. Am J Surg. 2010 May;199(5):e61-64
27 DeArmond DT, Cline AM, Johnson SB.Anastomotic leak detection by electrolyte electrical resistance[J]. J Invest Surg. 2010,23(4):197-203
28 Nair A, Pai DR, Jagdish S.Predicting anastomotic disruption after emergent small bowel surgery[J]. Dig Surg. 2006;23(5-6):369
29郑凤群,蔡建荣.食管贲门癌合并糖尿病患者吻合口瘘的治疗体会[J].临床军医杂志,2008,36(2):314-315
30 Sato N, Yamaguchi K, Yokohata K ,et al.Preoperative exocrine pancreatic function predicts risk of leakage of pancreaticojejunostomy[J]. Surgery. 1998 ,124(5):871-876
31赫鹏,白立炜.胃肠道手术后肠外瘘42例临床分析[J].河北医学,2005,8(11):1008-1009
32李兴睿,易继林.大剂量奥曲肽在肠瘘治疗中的应用[J].实用医学杂志,2005,21(5):521-522
33 Reynolds JV,FurrellyC,FeigheryC, eta.l Impaired gutbarrier func-tion inmalnourished patients[J]. Bri.l J. surgery, 1996, 83: 1288-1291
34任建安.肠外瘘并腹腔感染的细菌学与耐药分析[J].外科理论与实践,2001,6:252
35刘志毅刘艳玲.结肠梗阻急性手术中肠道准备的探讨[J].中国现代医学杂志,2003,13(23):137-138
36 Riss S, Stift A, Kienbacher C,et al.Recurrent abscess after primary successful endo-sponge treatment of anastomotic leakage following rectal surgery[J]. World J Gastroenterol. 2010 , 16(36): 4570–4574
37张代成,王世文,康迎新,等.7 1例大肠癌性梗阻急诊I期手术体会[J].兰州医学院学报,2004,3O(l): 41-43
38李伟,王明,王明轩.肠瘘30例的临床治疗[J].中华现代中西医杂志,2005,3(13):1191-1192
39卢正嘉,张志强,许蕾,等.肠瘘的临床分析[J].中外健康文摘,2008,5(24):55-56
40 Walker KG, Bell SW, Rickard MJ, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer[J]. Ann Surgery, 2004,240(2):255-259
41陈刚,谢亮,唐继鸣,等.食管癌术后颈部吻合口纵隔、胸腔内瘘的诊治——附5例报告及文献复习.癌症,2005,24(10):1280-1283
42 Müller-Wille R, Iesalnieks I , Christian Dorniaet,al.Influence of percutaneous abscess drainage on severe postoperative septic complications in patients with Crohn's disease[J]. Int J Colorectal Dis. 2011 ,1(1): [Epub ahead of print]
43 Binneb?sel M, Grommes J.Zinc deficiency impairs wound healing of colon anastomosis in rats[J]. Int J Colorectal Dis. 2010 Feb;25(2):251-257.
44 Pham NV, Cox-Reijven PL, Greve JW,et al, Application of subjective global assessment as a screening tool for malnutrition in surgical patients in Vietnam.Clin Nutr, 2006,25(1):102-108
45 Ghariani B, Houissa H, Sebai F.Early diagnosis of anastomotic dehiscence after colonic surgery[J]. Tunis Med. 2011,89(2):174-178
46邰建东,刘玉石,王广义.直肠癌保肛术后发生吻合口瘘的影响因素及其处理[J].中华胃肠外科杂志,2007,10(2):153-156
47梅斌臣.胃肠吻合口瘘的防治[J].中国误诊学杂志,2007,7(11):2513-2514
48 Doeksen A, Tanis PJ, Wüst AF,et al.Radiological evaluation of colorectal anastomoses[J].Int J Coloectal Dis, 2008 ,23(9):863-868
49窦会敏,赵国营,张俊乐,等,胸内食管胃吻合口瘘的CT诊断[J].临床研究,2007,45(7):48,55
50王寿强.食管癌贲门癌术后胸内吻合口瘘的治疗[J].实用肿瘤杂志,2002,17(5):347-348
51夏海娜,19例高流量消化道瘘引流的观察与处理[J].中原医刊,2005, 32(21):19-20
52张红卫,黎洪浩,王捷.持续腹腔冲洗引流治疗消化道瘘[J].中国实用外科杂志,2007,27(3):237-238
53罗健,黄卫,黄斌.油纱烟卷换药法在消化道瘘治疗中的应用价值[J].西部医学,2010,22(9): 1678-1679
54 Dearlove JL. Skin care management of gastrointestinal fistulas[J]. Surg ClinNorth Am. 1996,76:1095-1110
55 C Cro, K J George, J Donnelly,et al.Vacuum assisted closure system in the management of enterocutaneous fistulae[J]. Postgrad Med J 2002;78:364-365
56林志强,俞武生,叶振伟,等.25例消化道瘘的临床分析[J].岭南现代,临床外科,2008,8(3): 196-197,200.
57李宁,李有信,冯喆.清洁手术预防应用抗生素1∶1病例对照研究[J].中华医院感染杂志.2001,11(4):247-248.
58范书润,杨再珍,冯光强.食管贲门癌术后胸内消化道瘘诊治分析[J].医药论坛杂志,2007,28(13):52
59赵兰华.食管癌术后并发吻合口瘘的观察与护理[J].中华医药杂志,2003,3(1):89
60李群.链霉素局部使用治疗消化道瘘15例[J].基层医学论坛2003,7(4):352
61黎介寿,任建安,王新波,等.生长抑素与生长激素促进肠外瘘自愈的机理与临床研究[J].中华外科杂志,2000,38(6):447-448
62蒋婧.联合用药治疗上消化道瘘病人的护理[J].护理研究,2004 ,18 (9)1643-1645
63刘庆文黄冠群.PN在胃癌术后的临床应用[J].中国民族民间医药,2009,18(6):24-26
64 GouillatC, Chipponi J, Baulieux J, et al. Randomized controlled multicentre trial of somatostatin infusion afterpancreaticoduode-nectomy[J]. Br J Surg, 2001,88(11):1456-1462
65 Bodoky G,Harsanyi L,Pap A.Effect of enteral nutrition on exo-crine pancreatic function[J].Am J Surg,1991,161:144-148
66王琦,李琨,赫杰,等.胃癌切除术后吻合口瘘的营养支持[J].腹部外科,2008,,21(4):220-222
67保红平,杨浩雷,高瑞岗,等.腹部外科手术后肠内营养支持的临床研究[J].中华消化外科杂志,2007,6(1):32-34
68沈建辉.胃大部切除术后消化道瘘的原因和防治[J].苏州大学学报:医学版,2003,23(3):364-364,372
69肖君,张翼,谢虹.食管癌、贲门癌术后吻合口瘘的预防及处理[J].实用预防医学,2007, 14 (6):1869-1870
70陈业庭,杨林,朱青松,等.食管癌、贲门癌术后吻合口瘘的预防[J].世界医学,2006,11(3):32
71徐启明,周乃康,刘曦.食管癌贲门癌切除机械吻合术后胃食管反流的诊断和治疗[J].中国现代医学杂志,2006,16(14):2166-2169,2172
72张时绥.胃大部切除术后近期并发症的防治[J].中国普通外科杂志,1993,2(2)∶93
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