【摘要】 目的探讨食管癌术中吻合口旁预置负压引流管治疗吻合口瘘的有效性及安全性。方法回顾性分析2008年1月至2014年1月第二军医大学长征医院68例食管癌、贲门癌术后胸腔内吻合口瘘的临床资料。根据治疗方法的不同将患者分为3组,即吻合口旁预置负压引流管组(A组)、内镜下经鼻瘘口置入引流管组(B组)和传统治疗组(C组)。结果食管癌、贲门癌根治术胸内吻合1 251例,发生吻合口瘘68例(5.4%),死亡14例(20.6%);其中A组、B组患者死亡率少于C组,差异有统计学意义(14.3%、0vs 39.1%,P<0.05)。A组、B组重复置管次数均少于C组,差异有统计学意义(P<0.05);A组吻合口旁预置负压引流管时间短于B组、C组(P<0.05);A组、B组瘘口引流冲洗时间、恢复时间及胃肠减压时间短于C组,差异有统计学意义(P<0.05)。A组、C组鼻咽部明显不适感及导管堵塞发生率低于B组,差异有统计学意义(P<0.05)。除死亡患者外,各组吻合口瘘患者在经过积极治疗后均正常饮食,安全出院。结论吻合口旁预置负压引流管对胸腔吻合口瘘的治疗效果好,可缩短患者恢复时间,降低患者死亡率,减轻患者痛苦。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of presetting negative pressure drainage for anastomotic leakage after esophageal cancer surgery.Methods The clinical data of 68 patients with intrathoracic anastomotic leakage following surgery of esophageal and cardial carcinoma from January 2008 and January 2014 were retrospectively analyzed The patients were divided into 3groups,including presetting negative pressure drainage group(Group A),endoscopy drainage placement group(Group B)and traditional treatment group(Group C).Results A total of 1 251 patients underwent intrathoracic anastomosis were analyzed and anastomotic leakage occurred in 68cases(5.4%),with 14(20.6%)died after operation.The mortality rates of Group A and Group B were significantly lower than that in Group C(14.3%,0vs 39.1%,P<0.05).The repeated drainage times in Group A and Group B were signficantly less than that in Group C(P<0.05).Compared with Group B and Group C,Group A had the advantage of shorter manipulation time(P<0.05).Drainage lavaging time,recovery time and retaining time of gastric tube in Group A and Group B were significantly shorter than those in Group C(P<0.05).Patients in Group A and Group C had significantly less discomfort in nasopharynx and significantly lower obstruction incidence compared with those in Group B(P<0.05).Except for death,all patients with anastomotic leakage had normal diet and safe discharge after prompt treatment.Conclusion Presetting negative pressure drainage after esophageal cancer surgery has a better effect for anastomotic leakage by reducing recovery time,lowering mortality rate and alleviating the suffering of patients.更多还原