经腹放置纵隔引流管在食管癌“免管免禁”加速康复外科中应用的可行性分析

Feasibility of abdominal mediastinal tube placement for “non-tube no fasting” enhanced recovery after surgery in oesophageal cancer

目的探讨经腹放置纵隔引流管在"免管免禁"加速康复食管外科的可行性。方法食管癌根治术病人108例,分为A组56例和B组52例。所有病人均由同一术者行食管癌微创手术,术后仅放置纵隔管(无胸管、胃管、营养管等),所有病人均不禁食(术后第1天开始经口进食)。A组经胸放置纵隔引流管,B组经腹放置。比较两组病人手术、术后疼痛评分、术后并发症等发生情况。结果 A组和B组病人术后第1天引流管处最高疼痛评分较低分别为3. 9±0. 7和2. 3±0. 7,第2天分别为3. 5±0. 8和2. 1±0. 7,第3天分别为3. 3±0. 8和1. 7±0. 8,第4天分别为3. 1±0. 7和1. 7±0. 8,术后应用止疼药物(曲马多)占比分别为39. 3%和15. 4%,行胸腔积液闭式引流术分别为10. 7%和0,两组比较差异均有统计学有意义(P <0. 05)。结论微创食管癌根治术后经腹腔放置纵隔引流管可减轻术后疼痛,促进术后恢复。

Objective To study the feasibility of abdominal mediastinal drainage tube placement for'non-tube no fasting'enhanced recovery after surgery for oesophageal cancer. Methods 108 oesophageal carcinoma patients who underwent minimally invasive oesophagectomy( MIE) in our department.There were 56 cases in group A and 52 cases in group B. All patients underwent MIE by the same surgeon. Only the mediastinal canal was placed postoperatively( No chest tube,stomach tube,nutrition tube,etc). Group A were treated with a transthoracic mediastinal drainage tube,Group B were treated with an abdominal mediastinal drainage tube. The incidence of postoperative complications and pain scores were compared between the two groups. Results The maximum pain scores in Group B were significantly lower than those in Group A from the first to the fourth postoperative days:((3. 9 ± 0. 7) vs.( 2. 3 ± 0. 7),(3. 5 ± 0. 8)vs.(2. 1 ± 0. 7),(3. 3 ± 0. 8) vs.(1. 7 ± 0. 8) and(3. 1 ± 0. 7) vs.(1. 7 ± 0. 8),all P <0. 05)Group B contained fewer postoperative analgesic drug users[(39. 3% vs. 15. 4%),P < 0. 05],included fewer cases of closed thoracic drainage ((10. 7% vs. 0),P < 0. 05)Conclusion Mediastinal drainage tube placement in the abdominal cavity after MIE can reduce postoperative pain,promote postoperative recovery and improve postoperative quality of life. The treatment was safe and feasible.