臭氧胸腔保留灌注在食管癌术后吻合口瘘患者的应用

Application of thoracic perfusion with retained ozone in patients with anastomotic fistula after esophageal cancer surgery

目的观察臭氧胸腔保留灌注在食管癌术后吻合口瘘患者中的疗效。方法105例食管癌根治术后并发吻合口瘘的患者随机分为两组:对照组50例,采用胸腔闭式引流、抗感染、营养支持等常规治疗;试验组55例,在对照组治疗基础上加用臭氧胸腔保留灌注,每日1次,连续2周。记录两组相关临床资料,比较两组术前和术后第2天Hb、WBC、中性粒细胞百分比和血清白蛋白水平,记录细菌构成比和确诊吻合口瘘第1、3、6、9天胸腔引流液IL-6、IL-8、IL-10水平。结果两组患者肿瘤位置、肿瘤病理分期、手术时间、术中出血量、吻合口瘘发生时间、细菌构成比、术前和术后第2天Hb、WBC、中性粒细胞百分比、血清白蛋白水平以及确诊吻合口瘘第1天胸腔引流液IL-6、IL-8、IL-10水平差异均无统计学意义(P>0.05)。试验组确诊吻合口瘘第3、6、9天胸腔引流液IL-6、IL-8、IL-10水平低于对照组(P<0.05)。与对照组相比,试验组拔管时间早,抗生素使用时间和住院时间短,住院费用少,病死率低(P<0.05)。结论对食管癌术后吻合口瘘患者,在常规治疗基础上加用臭氧胸腔保留灌注能促进愈合,降低病死率,减少住院费用。

Objective To observe the efficacy of thoracic perfusion with retained ozone in the patients with anastomotic fistula after esophageal cancer surgery.Methods A total of 105 patients with anastomotic fistula after radical esophagectomy were randomly divided into two groups.Group C(50 cases)received conventional treatment including closed-chest drainage,anti-infection therapy and nutrition support.Group A(55 cases)received additional thoracic perfusion with retained ozone once a day for 2 weeks.The relevant clinical data of two groups were recorded.The Hb,WBC,percentage of neutrophils and serum albumin level before and on the 2^(nd)day after surgery,bacterial composition ratio,and levels of IL-6,IL-8 and IL-10 in pleural drainage fluid on the 1^(st),3^(rd),6^(th)and 9^(th)day after diagnosis of anastomotic fistula were compared between the two groups.Results There were no significant differences in tumor location,tumor pathological stage,surgical time,intraoperative bleeding volume,occurrence time of anastomotic fistula,bacterial composition ratio,Hb,WBC,percentage of neutrophils and serum albumin level before and on the 2^(nd)day after surgery,and the levels of IL-6,IL-8 and IL-10 in pleural drainage fluid on the 1^(st)day after the diagnosis of anastomotic fistula between the two groups(P<0.05).The levels of IL-6,IL-8 and IL-10 in the pleural drainage fluid on the 3^(rd),6^(th)and 9^(th)day after the diagnosis of anastomotic fistula in group A were lower than those in group C(P<0.05).Compared with group C,group A had earlier extubation time,shorter antibiotic use time and hospital stay,and lower hospitalization costs and mortality(P<0.05).Conclusion On the basis of conventional treatment,thoracic perfusion with retained ozone can promote healing and reduce mortality and hospitalization costs in the patients with anastomotic fistula after esophageal cancer surgery.