纵隔引流管在防治食管胸内吻合口瘘中的临床意义

Significance of mediastinum drainage tube in prevention and treatment of intrathoracic anastomotic leak after esophagectomy.

目的探讨纵隔引流管在防治术后食管胸内吻合口瘘中的临床意义。方法回顾性分析2006年至2008年180例食管癌及贵门癌患者（A组）手术中使用纵隔引流管对术后胸内吻合口瘘的发生率及预后的影响；同期选择我院2004年至2006年154例手术患者（B组）作对照比较。结果A组180例患者术后共发生食管胸内吻合口瘘3例，发生率为1．67％（3／180）；B组7例，发生率4．55％（7／154），2组食管胸内吻合口瘘发生率比较差异无统计学意义（Х^2=1．4807，P〉0．05）。A组确诊吻合口瘘的平均时间为术后（6．7±0．6）d，明显早于B组（10．0±2．1）d（t=2．62，P〈0．05）；A组平均发热持续时间（5．3±1．5）h，明显短于B组（43．0±20．9）h（t=4．39，P〈0．01）。预后比较，A组3例患者全部行保守治疗后痊愈出院，术后平均住院日（23．7±5．9）d，少于B组（45．3±5．0）d（t=4．86，P〈0．01）。B组7例患者2例保守治疗，皆死亡；5例行二次手术，其中3例成功，2例失败。该组病死率为2．60％（4／154），明显高于A组（0，Fisher概率法，P〈0．05）。结论纵隔引流管的有无与术后胸内吻合口瘘的发生与否无关，术中留置纵隔引流管的临床意义在于能早期发现吻合口瘘，并有效地控制纵隔感染，避免二次开胸手术，改善患者的预后。

Objective To explore the significance of mediastinum drainage tube in prevention and treatment of intrathoracic anastomotic leak after esophagectomy. Methods The morbidity and prognosis of intrathoracic anastomotic leak after esophagectomy in 180 patients with esophageal or cardia carcinoma （group A） who used mediastinum drainage tube in operation from 2006 to 2008 was studied retrospectively,and were compare with 154 patients （group B） without mediastinum drainage tube from 2004 to 2006. Results The morbidity of intrathoracic anasto- motic leak after esophagectomy was 1.67% （3/180） in group A,and 4.55% （7/154） in group B,but no difference between them（ Х^2 = 1. 4807 ,P 〉 0.05 ） were found. Compared to group B, the final diagnosis of anastomotic leak in group A was early [ （6.7 ± 0.6） vs（ 10.0 ± 2.1 ） days after operation（ t = 2.62 ,P 〈 0. 05） ] and the duration of fever was short [ （ 5.3 ± 1.5 ） vs （ 43.0 ± 20.9 ） hours （ t = 4.39, P 〈 0.01 ） ]. The prognosis of 3 cases in group A was well, who all recovered without operation and had shorten hospital days than group B [ （23.7 ± 5.9 ） d vs （45.3 ± 5.0） d, t = 4.86,P 〈 0.01 ） ]. In 7 cases of group B, there were 5 cases underwent second operation, but only 3 cases recovered, the case fatality rate was 2.60% （4/154）, higher than in group A （0, Fisher, P 〈 0.05 ）. Conclusions Although the mediastinum drainage tube used or not used in esophagectomy is unrelated with the occurrence of anastomotic leak, and the significance to use it is that it can help to discover anastomotic leak early, and control mediastinum infection effectively without reoperation,and improve patients＇ prognosis.