纵隔负压引流管在经右胸途径食管癌手术中的应用

Application of mediastinal vacuum drainage tube in the resection of esophageal carcinoma by the right chest

目的观察在经右胸行食管癌根治手术中,放置纵隔引流管对食管癌病人术后恢复、并发症发生及术后康复中临床意义。方法2013年10月~2020年4月收治的食管癌病人62例,均行经右胸食管癌根治手术治疗,按术中引流管放置情况分为两组:对照组29例,放置胸腔闭式引流管,研究组33例,放置胸腔闭式引流管联合纵隔负压引流管。比较两组病人手术时间、术后胸管引流量、带管时间、术后住院时间,术后肺部感染、吻合口漏发生率及吻合口愈合时间。结果两组病人手术时间、胸管引流量比较差异无统计学意义(P>0.05)。研究组带管时间及住院时间短于对照组,差异有统计学意义(P<0.05)。研究组术后肺部感染发生率低于对照组(15.2%vs.37.9%),差异有统计学意义(P<0.05)。两组术后均有3例病人发生吻合口漏,发生率比较差异无统计学意义(9.1%vs.10.3%,P>0.05)。研究组吻合口愈合时间短于对照组[(26.56±6.18)天vs.(40.13±8.14)天],差异有统计学意义(P<0.05)。结论纵隔引流可以缩短胸管留置时间,减少食管癌术后吻合口漏病人肺部感染发生率,缩短吻合口漏愈合时间,利于术后康复。

Objective To investigate the clinical significance of mediastinal drainage in radical resection of esophageal carcinoma via right chest for postoperative recovery,complications and prognosis of esophageal carcinoma.Methods Selection,Hefei Binhu hospital thoracic surgery in October 2013 to April 2020 treated 62 cases of patients with esophageal cancer and have walked right thoracic esophageal cancer radical surgery treatment,according to the intraoperative drainage tube placement is divided into two groups:among them,29 cases placed chest closed drainage tube(control group),33 cases were placed the chest closed drainage pipe joint mediastinal negative pressure drainage tube(study group).The operation time,postoperative chest tube drainage volume,duration of catheter insertion,postoperative hospital stay,postoperative pulmonary infection,incidence of anastomotic leakage and anastomotic healing time were compared between the two groups.Results There were no statistically significant differences in operation time or thoracic duct drainage between the two groups(P>0.05).The catheter duration and hospital stay in the study group were lower than those in the control group,and the difference was statistically significant(P<0.05).The incidence of postoperative pulmonary infection in the study group was lower than that in the control group(15.2%vs.37.9%),and the difference was statistically significant(P<0.05).Postoperative anastomotic fistula occurred in 3 patients in both groups,with no statistically significant difference in incidence(9.1%vs.10.3%,P>0.05).The anastomotic healing time of the study group was shorter than that of the control group[(26.56±6.18)d vs.(40.13±8.14)d],and the difference was statistically significant(P<0.05).Conclusion Mediastinal drainage can shorten the indwining time of thoracic duct,reduce the incidence of pulmonary infection in patients with anastomotic fistula after esophagectomy,shorten the healing time of anastomotic fistula,and facilitate the postoperative rehabilitation of patients.