食管癌术后胸内吻合口瘘的精确引流

Accurate Drainage for Intrathoracic Anastomotic Leakage after Esophagectomy

目的探索针对食管癌术后胸内吻合口瘘患者有效且微创的引流方法。方法自2012年1月至2014年12月在上海仁济医院胸外科针对14例食管癌术后胸内吻合口瘘伴包裹性积液的患者（男10例、女4例,年龄48～70岁）采取经超声引导下在瘘口旁置入12～14F J形可弯曲引流管的方法进行精确引流,同时配合胃肠减压及肠内营养治疗。结果无操作相关并发症发生,14例患者均治愈出院,引流时间17～89 d,每日引流量5～260 ml,总住院时间27～94 d。结论针对食管癌术后胸内瘘的患者经超声或CT引导下置入J形可弯曲引流管是有效且副损伤小的引流方法。

Objective To explore an effective and minimal invasive drainage procedure for intrathoracic anastomotic leakage after esophagectomy. Method A total of 14 patients（10 males and 4 females,aged 48 to 70 years） with encapsulated effusion due to thoracic anastomotic leakage after esophagectomy were performed accurate thoracic drainage which was guided by ultrasonography in Renji Hospital from January 2012 through December 2014. The J shape flexible catheter was placed into the effusion cavity near the leakage. Gasric drainage and enteral nutrition support were conducted as well. Result All the patients with leakage healed smoothly. The hospital stay was 27 to 94 days. Time of drainage was 17 to 89 days. The drainage volume was 5-260 ml per day. No complication related to drainage occurred. Conclusion Placing the J shape flexible catheter for plural drainage guided by ultrasonography or chest CT scan is a desirable and less injured therapy for intrathoracic leakage after esophagectomy.