经腹预防性放置纵隔引流管在防治高危食管胃食管空肠吻合口瘘中的作用

Application of trans-abdominal.mediastinal drainage tube in patients with high risk of esophagogastric or esophago-jejunai anastomotic leakage

目的探讨经腹预防性放置纵隔引流管在防治高危食管胃、食管空肠吻合口瘘中的作用。方法回顾性分析2007年8月至2011年8月间经胸腹联合行贲门癌根治性切除术、具有吻合口瘘高危因素的79例患者的临床资料。其中41例患者在手术消化道重建后，吻合口经腹预置纵隔引流管（改良组）；38例患者在手术消化道重建后，吻合口旁未预置纵隔引流管（对照组）。比较两组患者出现吻合口瘘后的临床表现以及预后情况。结果改良组发生吻合口瘘4例，4例患者的生命体征基本稳定，中位住院时间为29．3d。对照组发生吻合口瘘5例，术后均出现高热、胸闷。对照组发生吻合口瘘的5例患者中，4例患者行二次手术清创引流，其中3例治愈，1例死亡；1例患者在介入引导下，在吻合口旁放置引流管治愈。对照组吻合口瘘患者（除外1例死亡患者）中位住院时间为53．4d。两组患者中位住院时间比较，差异有统计学意义（P〈0．05）。结论虽然经腹预防性放置纵隔引流管不能预防高危食管胃、食管空肠吻合口瘘的发生，但能减轻吻合口瘘所致的全身炎症反应。

Objective To evaluate the therapeutic effects of trans-abdominal-mediastinal drainage tube on the prevention of esophagogastric or esophago-jejunal anastomotic leakage. Methods A total of 79 patients underwent thoraco-abdominal radical resection for gastric cardia cancer, with high risk of leakage of the anatsomosis, from Aug. 2007 to Aug. 2011 were included in this study. They were assigned into 2 groups. Forty one patients had trans-abdominal-mediastinal drainage tube （improvement group ） and 38 patients were without the mediastinal drainage tube （control group）. The clinical data of all the 79 patients were reviewed and the therapeutic effects of the two treatment approaches were compared. Results There was anastomotic leakage in four patients of the improvement group. They were with stable vital signs and the median hospital stay was 29.3 days. There was anastomotic leakage in five cases of the contol group and all of them had high fever and chest tightness. One among those five patients had transdermal placement of thoracic drainage tube and was cured, and four among those five patients had second debridement operation, with 3 cured and one death case. Except the one death case, the median hospital stay of the control group was 53.4 days, significantly longer than that of the improvement group （P 〈 0. 05 ）. Conclusions Although putting trans-abdominal-mediastinal drainage tube can not prevent the leakage of esophagogastric or esophago-jejunnal anastomosis, it can reduce the systemic inflammatory responses, death and painful suffering of the patients caused by anastomotic leakage.