四管法在食管癌术后吻合口胸腔瘘治疗中的疗效观察

Four-tube strategy for the treatment of thoracic cavity fistula following esophagus carcinoma resection

目的食管癌术后吻合口胸腔瘘是食管癌术后较严重的并发症,因治疗困难而造成的病死率极高。文中通过观察空肠造瘘管、胃管、胸腔引流管、经鼻瘘口管组成的"四管法"在食管癌术后吻合口胸腔瘘治疗中的疗效,探讨吻合口胸腔瘘更为合理的治疗方法。方法回顾性分析2008年6月至2014年6月在南京军区南京总医院心胸外科行食管癌根治术术后出现吻合口胸腔瘘的62例患者临床资料。其中采用"四管法"治疗35例为四管法组;胃管、胸腔引流管、经鼻空肠营养管"三管法"治疗27例为三管法组。观察2组在住院时间、愈合时间、病死率、随访术后6个月吻合口狭窄发生率等方面差异。结果四管法组较三管法组在住院时间[(45.89±7.15)d vs(75.89±10.93)d]和愈合时间[(41.91±7.22)d vs(72.59±10.89)d]方面明显缩短,差异有统计学意义(P<0.05),病死率明显降低(2.88%vs 18.52%,P<0.05);随访6个月吻合口狭窄发生率差异无统计学意义(P>0.05)。结论四管法较三管法可加快食管癌术后吻合口胸腔瘘患者的愈合速度、降低病死率,且不增加术后吻合口狭窄的发生率,是治疗食管癌术后吻合口胸腔瘘一种较理想的治疗手段。

Objective Thoracic cavity fistula following esophagus carcinoma resection is a serious complication with a high mortality. This study aims at a better therapy for thoracic cavity fistula following esophagus carcinoma resection by summarizing the ex- perience with the four-tube strategy （jejunal fistula tube, stomach tube, chest drainage tube, and nasal fistula tube） in the treatment of the complication. Methods We retrospectively analyzed the clinical data about 62 cases of thoracic cavity fistula following esopha- gus carcinoma resection, 35 treated with the four-tube strategy （treatment group） and the other 27 with the three-tube （stomach tube, chest drainage tube, and nasal fistula tube） method （control group）. We compared the hospital days, wound healing time, mortality, and incidence of anastomotic stenosis at 6 months after operation between the two groups of patients. Results Compared with the controls, the treatment group showed remarkable decreases in the hospital days （ P 〈 0.05 ）, wound healing time （ P 〈 0.05 ）, and mortality （P 〈 0.05 ）, but no statistically significant difference was observed in the incidence rate of anastomotic stenosis at 6 monthsafter operation between the two groups of patients （ P 〉 0. 05 ）. Conclusion Compared with the three-tube method, the four-tube strategy has the advantages of shorter healing time and lower mortality, and therefore is preferable for the treatment of thoracic cavity fis- tula following esophagus carcinoma resection.