压瘘进食法治疗颈部食管胃吻合口瘘的临床观察——单中心回顾性对比分析

Single Center Retrospective Comparative Analysis of the Treatment of Cervical Esophagogastric Anastomotic Fistula by Fistula-pressed Feeding

目的探讨压瘘进食法治疗食管颈部吻合口瘘的效果与理论基础。方法回顾性收集2017年1月至2022年1月于郑州大学第二附属医院胸外科行经左胸、左颈两切口食管癌根治术后发生颈部食管胃吻合口瘘的所有59例患者的临床资料。其中30例患者采用压瘘进食法处理,记为进食组;29例患者采用传统禁食法处理,记为禁食组。分析、比较两组患者的吻合口瘘愈合时间、瘘后住院时间、瘘后换药次数、电解质紊乱发生率、总体住院费用以及术前与术后血清总蛋白、白蛋白等营养指标等。结果两组患者颈部吻合口瘘均经保守治疗后痊愈,无再手术及死亡发生。两组患者的一般资料及术前营养状况,差异无统计学意义(P>0.05)。与禁食组相比,进食组的瘘口愈合时间、瘘后住院时间明显缩短,换药次数、电解质紊乱发生率及住院费用均明显减少,差异有统计学意义(P<0.05)。术后1个月,进食组患者的总蛋白、白蛋白、前白蛋白和血红蛋白均高于禁食组,差异有统计学意义(P<0.05)。结论压瘘进食法治疗颈部吻合口瘘,较传统禁食法可明显缩短瘘口愈合时间及住院时间,减轻医务人员工作量,降低住院花费,降低患者电解质紊乱发生率,早期恢复经口进食可以显著改善患者的营养状况。

Objective To investigate the effectiveness and feasibility of the fistula-pressed feeding method in the treatment of cervical esophageal anastomotic fistula.Methods Clinical data of 59 patients with cervical esophagogastric anastomotic fistula after radical resection of esophageal cancer through 2 incisions in the left chest and left neck were retrospectively collected in our hospital from January 2017 to January 2022.Among them,30 patients were treated with fistula-pressed feeding and recorded as the feeding group,29 patients were treated with traditional fasting method as fasting group.The healing time of anastomotic fistula,post-fistula hospitalization,the number of dressing changes for fistula-wounds,incidence of electrolyte disturbance,overall hospitalization cost,preoperative and postoperative serum total protein,albumin and other nutritional indicators were analyzed and compared between 2 groups.Results The cervical anastomotic fistula in both groups recovered after conservative treatment without reoperation and death.There was no significant difference between the 2 groups in general information and preoperative nutritional status(P>0.05).Compared with the fasting group,the fistula healing time of the fistula and the post-fistula hospitalization time in the feeding group were significantly shortened,and the number of dressing changes,the incidence of electrolyte disorders and the hospitalization expenses were significantly reduced(P<0.05).One month after operation,the total protein,albumin,prealbumin and hemoglobin of the patients in the feeding group were higher than those in the fasting group(P<0.05).Conclusion The treatment of cervical anastomotic fistula by the fistula-pressed feeding method can significantly shorten the time of fistula healing and hospitalization,reduce the workload of medical staff,lower the hospitalization cost,reduce the incidence of electrolyte disorders in patients.The early resumption of oral feeding can significantly improve the nutritional status of patients.