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后纵隔巨大畸胎瘤一例

带膜食管支架置入治疗食管癌术后胸内食管吻合口瘘

目的　总结覆硅胶膜镍钛合金食管支架置入治疗食管癌术后胸内食管吻合口瘘的临床经验。方法　回顾性分析 2005年 1月至 2009年 12月上海交通大学医学院附属仁济医院 12例食管癌手术后发生胸内食管吻合口瘘经覆硅胶膜镍钛合金食管支架置入治疗的临床资料，其中男 7例，女 5例；平均年龄 65（45～ 70）岁。胸内食管吻合口瘘发生于术后第 5～ 28 d，均为单个漏口，漏口直径约 0.2～ 1.0 cm。确诊食管吻合口瘘后给予支持治疗 7 d，待病情稳定后置入覆硅胶膜镍钛合金食管支架，支架长 5～ 12 cm ，内径 1.8～ 2.0 cm。结果　术后因进食呛咳死于肺部感染 1例。术后出现胸骨疼痛 7例，支架移位 3例，消化道出血 1例，均经相应的治疗后好转或治愈。生存患者于置入食管支架后第 3～ 15 d经口进食。随访 11例，随访时间 1～ 6个月，食管吻合口瘘愈合良好 9例；支架移位 1例，瘘口未愈合，术后 4个月死于肿瘤复发；在回收食管支架过程中黏膜撕裂，致吻合口狭窄 1例。结论　带膜食管支架置入是治疗食管癌术后胸内食管吻合口瘘的一种有效方法。

Preoperative NRS2002 Assessment of Nutritional Risk of Patients with Esophagus Cancer and Postoperative Results

ObjectiveTo evaluate nutritional risk of patients with esophagus cancer before operation using nutritional risk screening 2002 (NRS2002), and explore the relationship between nutritional risk score and postoperative results. MethodsWe prospectively evaluated the nutritional risk of 225 patients with esophagus carcinoma patients who were admitted in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between March 2012 and March 2013 using NRS2002, in accordance with disease severity score, nutritional status score and age score(age≥70 years old score was 1 point, < 70 years old for 0 point). There were 136 males and 89 females with age of 64.0±8.2 years (ranged from 41 to 85 years). Postoperative results include postoperative complications, mortality, and length of hospital stay. ResultsThe number of patients with preoperative score≥3 points was 75 (33.3%), < 3 points was 150 (66.7%). The incidence rate of postoperative complications was 26.7% in the patients with NRS2002 score≥3 points, and was 12.0% in those with NRS2002 score < 3 points(P < 0.05). And the total hospital stay time was longer in the patients with NRS2002 score≥3 points than that with NRS2002 score < 3 points(29.80±7.94 d vs. 15.30±2.05 d, P < 0.05). Logistic regression analysis showed that the preoperative NRS2002, the underlying diseases, and surgical method were risk factors for postoperative complications. ConclusionsPreoperative NRS2002 score≥3 points can predict more postoperative complications and longer hospital stay time in patients with esophagus carcinoma. It indicates that scientific nutrition support is necessary for esophagus carcinoma patients with NRS2002 score≥3 points. NRS2002 can be used as a predictive index of nutritional risk after operation of esophagus carcinoma.