纵隔留置引流管对治疗食管癌术后胸内吻合口瘘的临床价值

摘要

目的 探讨食管癌根治术中留置纵隔引流管对发生术后吻合口瘘的治疗作用.方法 回顾性分析2012年1月—2016年12月西安交通大学第二附属医院胸外科行食管癌根治性切除手术后发生吻合口瘘的患者45例,采用经左胸(Sweet)或上腹右胸(Ivor-lewis)术式,吻合口均位于胸腔内.其中放置常规胸腔闭式引流管后关胸(对照组)22例,放置常规胸腔闭式引流管后再于食管床放置纵隔引流管(研究组)23例.比较2组患者吻合口瘘确诊时间、术后平均最高体温、平均白细胞计数峰值、治愈时间、心肺并发症、病死率以及预后随访吻合口狭窄等情况.结果 研究组术后吻合口瘘确诊时间组早于对照组(t=3.834,P<0.01),且纵隔引流管的引流量约占胸腔总引流量的70%[胸腔总引流量(753.6±136.4)ml,纵隔引流量(536.8±108.3)ml];研究组术后平均最高体温、平均白细胞计数峰值低于对照组(t=8.965、6.185,P<0.01),吻合口瘘治愈时间明显短于对照组,且其之间差异具有统计学意义(t=11.237,P<0.01).术后对侧胸腔积液行穿刺引流例数少于对照组(χ2=2.522,P<0.05),术后心肺并发症发生率病死率低于对照组(χ2=2.741、1.755,P<0.05),但2组患者出院后6个月吻合口狭窄率之间比较,差异无统计学意义(χ2=0.897,P>0.05).结论 术中放置纵隔引流管有助于早期发现吻合口瘘、更好地通畅术后胸腔引流、降低对侧胸腔积液发生率、减轻术后全身炎性反应症状、减少心肺并发症的发生、缩短吻合口瘘的治愈时间、降低吻合口瘘所致病死率,值得临床推广使用,但对术后出现吻合口狭窄与否无明显影响.%Objective To investigate the therapeutic effect of anastomosis leakage in resection of esophageal carcino -ma with drainage in mediastinum.Methods Forty-five cases with esophageal carcinoma underwent radical operation(Sweet or Ivor lewis)suffered anastomosis leakage between January 2012 to December 2016 were retrospectively analyzed.There were 22 cases which were control group without mediastinal drainage tube and 23 cases which were study group with mediastinal drain-age tube in original esophagus bed.The drainage was placed under the anastomosis of esophageal and gastric about 1.0-2.0 cm.We observed changes in a range of clinical indicators after surgery in the two groups.Result:All patients with anasto-motic leakage were treated with positive treatment,32 cases cured and 13 cases died.The postoperative variations of the peri-od of time which confirmed diagnosis of anastomotic leakage(t=3.834,P<0.05),mean maximum temperature(t=8.965, P<0.05),mean maximum leukocyte count(t=6.185, P<0.05),the number of patients with hydrothorax of contralateral lung need to puncture and drainage(χ2=2.522,P<0.05),the number of patients which suffered cardiopulmonary complica-tion(χ2=2.741,P<0.05),the fatality rate by anastomotic leakage(χ2=1.755,P<0.05),the period of time for recovery after anastomotic leakage(t=11.237,P<0.05)were statistically significant in two groups.The number of patients which suffered anastomotic stenosis at 6 months need dilated after surgery were not statistically significant(χ2=0.897,P>0.05)in two groups.The volume of the mediastinal drainage tube(536.8 ±108.3)ml accounts for about 70% of the total volume of thoracic drainage(753.6 ±136.4)ml in study group.Conclusion Placing a esophageal bed mediastinal drainage tube in radical operation for esophagus cancer was valuable for early diagnosis and treatment of anastomotic leakage as well as shorting the recovery course of anastomotic leakage and reducing mortality caused by anastomotic leakage.It is worthwhile for clinical use.However,there was no obvious effect on postoperative anastomotic stenosis.