预置食管床引流管治疗胃食管胸内吻合口瘘的临床研究

Treatment of anastomosis fistula in resection of esophageal carcinoma with drainage in mediastinum

目的探索预防胃食道胸内吻合口瘘的新方法及食管床引流在吻合口瘘治疗中的作用。方法回顾分析自1997年8月～2007年8月间本院收治的食管贲门癌根治性切除患者846例,预置食管床引流管431例,其中未预置食管床引流管415例。食道、贲门癌切除后胃代食管经食管床主动脉弓上、胸顶或颈部吻合。吻合完成后将胸胃向上悬吊3～4cm,在吻合口下方1～1.5cm放置乳胶引流管沿食道床向下从前胸壁引出,严密关闭左侧纵膈胸膜。结果846例患者中,预置食管床引流管组术后发生吻合口瘘18例(18/431),未预置食管床引流管组术后发生吻合口瘘15例(15/415),发生率无显著性差异(P>0.05)。预置食道床引流管而发生吻合口瘘的18例患者。未预置食管床引流管发生吻合口瘘的15例患者。其中2例行二次开胸放置食管床引流管而治愈。两组最高体温及白细胞差异均有显著性(P<0.05)。结论放置食管床引流管不能对吻合口瘘的发生起预防作用,但重要的是可以明显减轻吻合口瘘引发的胸腔感染所致的高热、呼吸困难等全身感染中毒症状。

Objective To research the effective methods of preventing esophageal and gastric anas- tomotic leakage and the function of the drainage in mediastinum, Methods 846 cases with esophageal carcinoma between August 1997 to August 2007 was retrospectively analyzed. There were 415 cases without drainage and 431 cases with drainage in mediastinum. The drainage was placed in mediastinum, where were under the anastomosis of esophageal and gastric about 1.0-- 1.5cm. The tube was extracted from the front of left thorax following closing the left mediastinum pleura. Results There was no differ- ence in statistics between the group with drainage（18/431）and the group without drainage（15/415） in the rate of anastomotic leakage; there was significant difference in poisonous behavior such as temperature and leukocyte. Conclusions Drainage in mediastinum can not prevent anastomosis leak of esophageal and gastric. But that can relieve the poisonous symptoms such fever, dyspnea and so on.