食管床低负压引流在食管癌术后胸内吻合口瘘早期诊断及治疗中的应用

Placement of esophageal bed drainage with low negative pressure for early diagnosis and treatment of intrathoracic esophageal anastomotic leakage

目的吻合口瘘是食管癌术后严重的并发症。文中观察放置食管床低负压引流管对食管癌手术后胸内吻合口瘘早期诊断及疗效,并探讨食管床低负压引流的临床应用价值。方法回顾性分析2013年3月至2015年11月期间于济宁医学院附属湖西医院216例行食管胃胸内吻合术的食管癌患者临床资料。其中124例患者完成食管癌根治性切除食管胃胸内吻合后,置入常规胸腔闭式引流管及食管床低负压引流管各1根(低负压组);92例患者行食管癌根治性切除食管胃胸内吻合后,仅置入1根常规胸腔闭式引流管(对照组)。比较2组术后胸内吻合口瘘发生率的差异以及发生吻合口瘘病例的确诊时间与瘘后恢复(自确诊瘘至恢复经口进食)时间差异。结果低负压组与对照组术后吻合口瘘发生率差异无统计学意义(5.64%vs 4.34%,P>0.05),发生食管胸内吻合口瘘患者吻合口瘘确诊时间[(5.43±1.62)d vs(8.25±2.22)d]及瘘后恢复时间[(29.29±10.18)d vs(78.50±20.27)d]差异有统计学意义(P<0.05)。结论放置食管床低负压引流管有助于早期发现吻合口瘘的发生,有利于及早治疗及缩短吻合口瘘的瘘后恢复病程。

Objective Anastomotic leakage is a serious complication after esophagectomy,we try to observe the early diagnosis and treatment of intra-thoracic anastomotic leakage following esophagectomy through placing an esophageal bed drainage tube with low negative pressure on,and to explore the clinical value of esophageal bed drainage tube with low negative pressure. Methods We retrospectively analyzed the clinical data of 216 patients with esophageal carcinoma receiving intra-thoracic esophagogastro-anastomosis in our hospital from Mar.2013 to Nov.2015. There were 124 patients were placed an esophageal bed drainage tube with low negative pressure and a closed thoracic drainage tube after surgery（ low negative pressure group）,and 92 patients were just place a closed thoracic drainange tube（ control group）. Compared the differences of the incidence rate of intra-thoracic anastomotic leakage,the time of confirmed diagnosis and the time of recovery after anastomotic leakage（ time from confirmed diagnosis to recover oral intake） between the two groups. Results There was no difference in incidences of anastomotic leakage in two groups（ 5.65% vs 4.34%,P〉0.05）,however,diagnosis of anastomotic leakage in experiment group was earlier than that of control group（ [5.43±1.62]d vs [8.25±2.22]d,P〈0.05） and the period of time for recovery after anastomotic leakage was shorter than control group（ [29.29±10.18]d vs [78.50±20.27]d,P〈0.05）. Conclusion Placing a esophageal bed drainage tube with low negtive pressure in esophagectomy could be valuable for early diagnosis and treatment of anastomotic leakage as well as shorting the recovery course of anastomotic leakage after esophagectomy.