| 马明平， 刘进生， 王增林， 周东升， 杜瑞宾.CT引导下置管引流治疗胃癌切除术后胃肠道瘘[J].放射学实践,2014,(07):841-844 |
| CT引导下置管引流治疗胃癌切除术后胃肠道瘘 |
| Percutaneous catheter drainage under CT guidance in treatment of gastrointestinal leakage after gastrectomy for gastric cancer |
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| DOI：10.13609/j.cnki.1000 0313.2014.07.027 |
| 中文关键词: 胃肠道瘘 经皮穿刺引流术 体层摄影术，X线计算机 |
| 基金项目:福建省自然科学基金（2010J01126） |
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| 【摘要】目的：评价CT引导下置管引流治疗胃癌切除术后胃肠道瘘的疗效。方法：回顾性分析2009年7月-2013年12月共17例胃癌切除术后吻合口瘘及十二指肠残端瘘患者的病例资料，所有病例均行CT引导下经皮穿刺放置引流管交替冲洗引流或持续冲洗引流，并结合持续胃肠减压、抗感染、肠外、肠内营养支持等综合治疗措施进行治疗。结果：所有病例均在CT引导下顺利置入引流管，7例置入单根引流管，10例置入两根引流管。16例(94%)经过引流结合抗感染、营养支持等治疗4～12周后CT复查原积液逐渐吸收、消失，消化道碘水造影显示胃空肠吻合口瘘及食管空肠吻合口瘘闭合，CT扫描显示十二指肠残端瘘残端周围积液腔吸收、消失。16例随访3～6个月胃肠道瘘无复发，1例食管空肠吻合口瘘经穿刺引流及再次手术后仍死于严重感染。结论：CT引导下经皮穿刺放置引流管结合营养支持等综合治疗是胃癌切除术后胃肠道瘘的有效治疗手段，尤其是多根引流管结合生理盐水冲洗引流可能有助于提高引流效果，促进瘘口愈合。 |
| 【Abstract】Objective:To evaluate the effectiveness of percutaneous catheter drainage under CT guidance in the treatment of gastrointestinal leakage after gastrectomy for gastric cancer.Methods:From July 2009 to December 2013,the clinical data of 17 cases of gastrointestinal leakage including anastomotic leakage in 13 cases and duodenal stump leakage in 4 cases after gastrectomy for gastric cancer were analyzed retrospectively.All the patients were treated with percutaneous catheter drainage under CT guidance combined with other comprehensive treatment including continuous gastrointestinal decompression,administration of antibiotic and parenteral nutrition and enteral nutrition.Results:Percutaneous catheter drainage under CT guidance was successfully performed in all the patients.Single catheter was placed in 7 cases and two catheters were placed in 10 cases.After percutaneous catheter drainage combined with other comprehensive treatment,leakage closure was achieved in 16 (94%) patients and fluid collection around leakage had gradually disappeared on CT images in 4 to 12 weeks of follow-up.Anastomotic leakage closure was confirmed by gastrointestinal fluoroscopy using nonionic contrast agent and duodenal stump leakage was confirmed with CT scan.All 16 cases were followed up 3 to 6 months and no recurrence of gastrointestinal leakage was observed.One patient died of leakage associated complications including severe infection even after percutaneous catheter drainage and re-operation.Conclusion:Percutaneous catheter drainage under CT guidance combined with other comprehensive treatment was effective methods for gastrointestinal leakage after gastrectomy for gastric cancer.More than one catheter placement around leakage with sterile saline flushing and drainage maybe more efficacious in promoting leakage closure. |
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