KẾT QUẢ ĐIỀU TRỊ RÒ MỎM TÁ TRÀNG SAU CẮT ĐOẠN DẠ DÀY DO UNG THƯ DẠ DÀY VÀ RÒ TIÊU HÓA CAO

Abstract

Study aim: 1. Evaluation the clinic feature and risk factors of duodenal stump fistula and upper gastrointertinal  fistula post gastrectomy for gastric cancer or post duodenal segmentectomy for cancer. 2. The method and result of duodenal stump fistula and upper gastrointertinal fistula treatment. Patient and method: + Retrospective study. + Time 2018-2023. Result: There were 15 patients,Male 10 patients (66,6%), female 5 patients (33,4%), mean age 62,3 years. Operations performed: 11/15 patients had subtotal gastrectomy with D2 lymph node dissection (among them, 6 patients had duodenostomy); 2 patients had duodenal segmentectomy and antrectomy with duodenostomy for decompression, 1 patient had duodenal DIII-DIV segmentectomy and gastrojejonostomy; 1 had duodeno-pancreatectomy encephalic resection. There were 9 patients who had duodenal stump fistula post subtotal gastrectomy, 1 patient had upper gastrointertinal fistula post gastrectomy and jejunal resection with high out put, one had gastrojejunal anastomosis fistula with high output.1 had gastrojejunal anastomosis fistula post duodeno pancreatic encephalic resection for tumor of pancreatic head.All patients had conservative treatment included: total parenteral nutrition, infection control,skincare,octreotide given. The average  healing time was 13,2 days (range 6-72 days), 3 patients had pecutaneous drainage, 3 others patients with high output had the suction and irrigation system. No death post treatment. All fistula closure. Conclusion: We conclude that conservative treatment include: total parenteral nutrition, infection control, skin care, octreotide used in association with percutaneous drainage and irigation and suction system with high out put fistula were satisfactory method of duodenal stump fistula post gastrectomy for gastric cancer and post duodenal segmentectomy fistula. In case of technical difficulty in duodenal stump closure or duodenal segmentectomy, duodenostomy for decompresion should be performed.