Abstract:

Objective:To summarize the nutritional supporting experiences in anastomotic leakage following esophagogastrostomy or esophagojejunostomy after gastrectomy for gastric carcinoma and to increase the level of treatment of anastomotic leakage following esophagogastrostomy or esophagojejunostomy. Methods:A total of 19 cases of anastomotic leakage following esophagogastrostomy (6 cases) or esophagojejunostomy (13 cases) after gastrectomy for gastric carcinoma in PLA General Hospital from January 1997 to December 2006 were analyzed retrospectively. Results:All of the cases were treated with abdominal cavity drainage,continuous gastrointestinal decompression and parenteral nutrition combined with enteral nutrition.Sixteen cases were given glutamine enrichment.Ninteen cases were infused somatostatin.Five cases were supplemented recombinant human growth hormone.Four cases′ fistula had been healed after gastrectomy for gastric carcinoma 21～30d.Twelve cases′ fistula had been healed 30～60d.Two cases′ fistula had been healed 60～81d.One case complicated with severe sepsis of thoracic cavity,lung and abdominal cavity died 42d after gastrectomy for gastric carcinoma. Conclusion:The treatment with abdominal cavity drainage,continuous gastrointestinal decompression,parenteral nutrition combined with enteral nutrition,glutamine,somatostatin and recombinant human growth hormone are the important factors for healing of anastomotic leakage following esophagogastrostomy or esophagojejunostomy after gastrectomy for gastric carcinoma.

Key words: gastric carcinoma, anastomotic leakage, enteral nutrition, parenteral nutrition

摘要：

目的:总结胃癌切除术后食管胃或食管空肠吻合口漏的营养支持经验,以提高对食管胃或食管空肠吻合口漏的治疗水平。方法:对1997年1月至2006年12月,中国人民解放军总医院治疗的胃癌切除术后6例食管胃吻合口漏和13例食管空肠吻合口漏共19例病人进行回顾性分析。结果:19例均加强吻合口附近的腹腔引流,采用持续胃肠减压,均先给予肠外营养支持、然后从肠外营养支持逐步过渡到肠内营养支持的治疗手段。16例在肠外营养液中强化了谷氨酰胺，19例均使用生长抑素，5例在吻合口漏愈合期加用了生长激素。在首次胃癌切除术后,4例漏口21～30d自愈,12例漏口30～60d愈合，2例漏口60～81d愈合，1例因严重的左侧胸腔、肺部感染合并腹腔感染于首次胃癌切除术后42d死亡。结论:保证腹腔引流的通畅、持续胃肠减压，特别是肠外结合肠内营养支持、强化谷氨酰胺、生长抑素、生长激素等措施,是促进胃癌切除术后食管胃或食管空肠吻合口漏愈合的重要手段。

关键词: 胃癌, 吻合口漏, 肠内营养, 肠外营养