经食管裂孔留置纵隔引流对胸腹腔镜食管癌术后吻合口瘘的影响

Effect of trans-esophageal hiatus-mediastinal drainage on anastomotic leakage after thoracoscopic laparoscopic esophagectomy

目的介绍胸腹腔镜食管癌根治术中经食管裂孔留置纵隔引流管并经右侧腹壁引出固定引流管的方法,评判其对术后吻合口瘘发生的影响。方法回顾性分析2015年7月至2018年7月间扬州大学附属苏北人民医院胸外科收治的行胸腔镜食管癌手术患者共380例,均行经颈胸腹三切口行食管癌切除手术(McKeown手术),颈部食管胃手工吻合。其中2015年7月至2017年9月经颈部留置纵隔引流298例(A组),2017年10月至2018年7月经食管裂孔留置纵隔引流82例(B组),观察术后吻合口瘘发生的情况。两组患者均由同一组手术医生完成,颈部吻合由同一医生完成。结果两组患者均顺利完成手术,无围手术期死亡。B组吻合口瘘发生率明显低于A组(3.66% vs.16.1%,P=0.003),其中A组发生吻合口瘘入纵隔或胸腔5例,其中1例发生食管气管瘘,经治疗后均治愈出院。结论通过经食管裂孔留置纵隔引流管可以改善胸腹腔镜食管癌根治术后吻合口周围及纵隔内积液的引流,减少术后吻合口瘘的发生。

Objective To introduce the method of placing mediastinal drainage tube through esophageal hiatus and fixing drainage tube through right abdominal wall in thoracoscopic laparoscopic esophagectomy for esophageal carcinoma,and to evaluate its influence on postoperative anastomotic leakage.Methods A total of 380 patients undergoing thoracoscopic laparoscopic esophagectomy were retrospectively included in this study from July 2015 to July 2018 in Department of Cardiothoracic Surgery of Northern Jiangsu People's Hospital.All of them underwent McKeown operation and cervical esophagogastric anastomosis by hand.From July 2015 to September 2017,298 cases were treated with trans-cervix-mediastinal drainage(group A),and from October 2017 to July 2018,82 cases were treated with trans-esophageal hiatus-mediastinal drainage(group B).The occurrence of anastomotic leakage after the operation was observed.The two groups of patients were completed by the same group of surgeons,and the anastomosis was completed by the same doctor.Results The incidence of anastomotic leakage in group B was significantly lower than that in group A(3.66% vs.16.1%,P=0.003).Five patients in group A had anastomotic leakage into the mediastinum or thoracic cavity,one of them had esophagotracheal fistula,and all patients were cured and discharged after treatment.Conclusion Placing mediastinal drainage tube through esophageal hiatus can improve the effusion drainage around the anastomosis and mediastinum of thoracoscopic laparoscopic radical resection of esophageal cancer and reduce the incidence of postoperative anastomotic leakage.