多学科联合诊治食管癌术后吻合口瘘对预后的影响

Multidisciplinary diagnosis and treatment of anastomotic leakage in esophageal cancer and its effect on prognosis

目的早期诊断和及时有效的治疗是降低食管癌术后吻合口瘘病死率和改善预后的关键,其诊断及治疗涉及多个学科。文中旨在探讨多学科联合诊治在食管癌术后吻合口瘘中的应用价值。方法回顾性分析2013年6月至2018年6月接受食管癌切除的986例患者,其中术后出现吻合口瘘的患者作为研究对象,共纳入82例。将2013年6月至2015年12月常规诊疗方式的43例患者为对照组,2016年1月至2018年6月开展多学科联合治疗的39例患者为多学科组(胸外科、影像科、普外科、营养科等组成多学科联合诊疗团队进行联合诊治)。统计分析2组一般资料、预后情况及瘘管愈合时间。结果多学科组隐匿瘘比例显著高于对照组(38.5%vs18.6%),差异有统计学意义(P<0.05)。吻合口瘘愈合时间[(17.24±3.62)d]明显短于对照组[(33.85±4.85)d],差异有统计学意义(P<0.05)。结论多学科联合诊治易于发现隐匿瘘,从而缩短吻合口瘘治愈时间,值得临床推广。

Objective Early diagnosis and effective treatment are the key to reduce the mortality and improve the prognosis of anastomotic leakage which involved many disciplines after esophageal cancer surgery.The aim of the study is to investigate the value of multidisciplinary which combined diagnosis and treatments in anastomotic leakage after esophageal cancer operations.Methods A total of 82 patients with anastomotic leakage after esophageal cancer surgery in our hospital from June 2013 to June 2018.43 patients from June 2013 to December 2015 were included in the control group.39 patients with anastomotic leakage from January 2016 to June 2018 were used as the observation group.Patients in the control group were given routine diagnosis and treatment,while the ob-servation group was given a multidisciplinary(thoracic surgery,imaging,general surgery,nutrition,etc.)joint diagnosis and treat-ment model.Observe general data,prognosis,and fistula healing time.Results The proportion of occultation in the observation group was significantly higher than that in the control group(38.5%vs 18.6%),and the difference was statistically significant(P<0.05).The healing time of anastomotic leakage was lower in the observation group[(17.24±3.62)d]than in the control group[(33.85±4.85)d](P<0.05).Conclusion Multidisciplinary combined diagnosis and treatment can improve the incidence of occult sputum and reduce the healing time of anastomotic leakage.It is worthy of clinical promotion.