食管癌手术中纵隔引流管的应用

The application of mediastinal drainage tube in the operation of esophageal cancer

目的分析食管癌手术中安置纵隔引流管对术后吻合口瘘的影响。方法选择2007年5月-2017年5月收治的食管癌手术患者426例,术毕时单纯安置胸腔引流管202例(胸腔引流组),同时安置纵隔引流管与胸腔引流管224例(纵隔引流组),比较2组术后吻合口瘘发生率、呼吸衰竭发生率、病死率、术后最高体温、白细胞计数、胸腔置管时间、住院时间。结果 2组术后吻合口瘘发生率比较差异无统计学意义(P> 0.05);纵隔引流组呼吸衰竭发生率、病死率均低于胸腔引流组,差异均有统计学意义(P <0.05);纵隔引流组最高体温、白细胞计数、胸腔置管时间、住院时间均优于胸腔引流组,差异均有统计学意义(P <0.05)。结论食管癌手术中安置纵隔引流管可以降低术后吻合口瘘的感染症状,减少胸腔置管时间和住院时间,降低吻合口瘘的呼吸衰竭发生率和病死率,是治疗吻合口瘘较好的方式,值得临床推广。

Objective To analyze the therapeutic value of mediastinal drainage tube in the operation of esophagus carcinoma for postoperative anastomotic fistula.Methods 426 patients with esophageal cancer surgery from May 2007 to May2017 were selected,the patients with chest drainage tube placement（202 cases,chest group）,and placement of chest drainage tube and mediastinal drainage tube（224 cases,mediastinal drainage group）,the incidence of anastomotic leakage,respiratory failure,mortality,postoperative maximum body temperature,white blood cell count,chest tube placement time,and hospitalization time were compared between the two groups.Results There was no significant difference in the incidence of postoperative anastomotic leakage between the two groups（P〉0.05）.The incidence and mortality of respiratory failure in the mediastinal drainage group were lower than those in the chest drainage group,and the differences were statistically significant（P〈0.05）.The highest body temperature,white blood cell count,chest tube placement time and hospitalization time in the mediastinal drainage group were superior to those in the chest drainage group（P〈0.05）.Conclusion Placement of the mediastinal drainage tube during esophageal cancer surgery can reduce the infection symptoms of postoperative anastomotic leakage,reduce the time of chest tube placement and hospitalization,reduce the incidence of respiratory failure and mortality of anastomotic leakage,and it is a better way to treat anastomotic leakage,it is worthy of clinical promotion.