经鼻瘘腔内置引流管治疗食管癌术后吻合口-纵隔瘘6例

Drainage tube placement via transnasal route for the treatment of mediastinal anastomotic fistula after surgery of esophageal cancer: clinical analysis of 6 cases

目的回顾性分析X线监视下经鼻瘘腔内置入引流管的方法治疗食管癌术后吻合口-纵隔瘘的可行性。方法 2015年8月至2016年1月,6例经食管造影及胸部CT证实为食管癌术后吻合口-纵隔瘘的患者,在X线监视下,经鼻在导丝引导下于纵隔瘘腔内置入引流管并持续负压吸引,如患者未放置营养管,则经同一鼻孔置入空肠营养管。结果 6例患者全部成功置入瘘腔引流管及空肠营养管,1例患者在置管后5 d因引流管堵塞,重新置入引流管。在X线监视下置管时间为23~48 min,平均33 min。6例患者均能够耐受,未出现经鼻置管并发症。经过持续负压吸引6~40 d(平均23 d),患者瘘口愈合。结论 X线监视下经鼻瘘腔内置入引流管治疗食管癌术后吻合口-纵隔瘘的方法简便、安全、有效。

Objective To evaluate the clinical feasibility of performing the placement of drainage tube via transnasal route in treating mediastinal anastomotic fistula after surgery of esophageal cancer. Methods A total of 6 patients with mediastinal anastomotie fistula after surgery of esophageal cancer, who were admitted to authors＇ hospital during the period from August 2015 to January 2016, were included in this study. The diagnosis was confirmed by esophageal radiography and thoracic CT scan in all the 6 patients. Under X-ray monitoring, the drainage tube was inserted into the cavity of mediastinal fistula with the help of a guide wire guidance, and continuous negative pressure suction was adopted. The jejunum nutrition tube was inserted via the same nostril if feeding tube was not placed. Results Successful placement of fistula drainage tube and jejunum nutrition tube was achieved in all the 6 patients. In one patient the fistula drainage tube had to be re-placed as the drainage tube was obstructed five days after initial placement. Under X-ray monitoring the mean time used for the drainage tube placement was 33 rain （range of 23-48 rain）. The procedure was well tolerated by all the 6 patients, and no procedure-related complications occur-red. After continuous negative pressure suction that lasted for 6-40 days （mean of 23 days） the fistulae healed. Conclusion For the treatment of mediastinal anastomotic fistula after surgery of esophageal cancer, the placement of fistula drainage tube under X-ray monitoring is simple, safe and effective.