纵隔橡皮引流管在食管癌及食管胃交界部癌术后吻合口瘘中的应用  

Clinical application of mediastinal elastic drainage-tube for patients with anastomotic leak after esophagus carcinoma or esophagogastric junction carcinoma surgery

作　　者：许彬东[1] 黄国忠[1] 陈豪[1] 张强[1] 

机构地区：[1]莆田学院附属医院胸心外科莆田市临床重点专科,351100

出　　处：《中国综合临床》2017年第3期231-235,共5页Clinical Medicine of China

摘　　要：目的 探讨纵隔橡皮引流管在食管癌及食管胃交界部癌术后吻合口瘘中的应用价值.方法 选取食管癌及食管胃交界部癌患者282例,随机双盲分为试验组（常规留置胸腔闭式引流管及额外留置纵隔橡皮闭式引流管,142例）和对照组（仅常规留置胸腔闭式引流管,140例）.比较两组患者手术后吻合口瘘的发生率、吻合口瘘的确诊时间、最高体温、持续发热时间、白细胞总数、心肺并发症发生率、术后住院时间、术后住院总费用.结果 （1）试验组和对照组的吻合口瘘发生率分别为9.8%（14/142）和12.1%（17/140）,两者比较差异无统计学意义（χ^2=0.376,P〉0.05）.（2）试验组吻合口瘘的确诊时间、最高体温、发热持续时间、白细胞总数与对照组比较差异均有统计学意义[（6.4±0.6） d与（10.6±0.6） d、（38.1±0.1）℃与39.0±0.2）℃、（72.2±2.8） h与（102.6±3.3） h、（12.6±0.7）×10^9/L与（19.7±0.6）×10^9/L;t值分别为2.708、1.662、3.164、1.837,P均〈0.05].肺部并发症发生率、心脏并发症发生率两组比较差异均有统计学意义[19.7%（28/142）与32.1%（45/140）、18.3%（26/142）与40.7%（57/140）;χ^2值分别为5.077、6.606,P均〈0.05）].术后住院时间、术后住院总费用两组比较差异均有统计学意义[（28.1±4.2）d与（45.6±3.9）d、（68174.7±3206.5）元与（84774.8±4007.3）元;t值分别为2.001、1.709,P均〈0.05].结论 术中额外留置纵隔橡皮闭式引流管不能降低吻合口瘘的发生率,但有利于吻合口瘘的早期确诊、及时治疗,降低心肺并发症发生率,缩短术后住院时间,降低术后住院总费用.Objective To study the clinical application of mediastinal elastic drainage-tube for patients with anastomotic leak after esophagus carcinoma or esophagogastric junction carcinoma surgery.Methods Two hundred and eighty-two cases esophagus carcinoma or esophagogastric junction carcinoma patients were randomly divided into 2 groups.The control group（n=140） were indwelled thoracic drainage tube after operation.However,the experimental group（n=142） were indwelled thoracic drainage tube and mediastinal elastic drainage-tube after operation.The incidence of the esophagogastrostomy fistula,diagnosis time of anastomotic leakage,maximum temperature,time of continuous ferer,total white blood cell count,cardiopulmonary complications,postoperative hospital stay,hospitalization expenses were observed and analyzed.Results （1）The incidence of the esophagogastrostomy fistula in the experimental group and the control group was 9.8%（14/142） and 12.1%（17/140）,and there was no significant difference between the two groups（χ^2=0.376,P〉0.05）.The diagnosis time of anastomotic leakage,maximum temperature,time of continuous ferer and total white blood cell count of the experimental group and the control group was （6.4±0.6） d and （10.6±0.6） d,（38.1±0.1）℃ and （39.0±0.2）℃,（72.2±2.8） h and （102.6±3.3） h,（12.6±0.7）×10^9/L and （19.7±0.6）×10^9/L after operation,there was significant difference between the two groups（t=2.708,1.662,3.164,1.837,P〈0.05）.The incidence of pulmonary complication,cordis complication of the experimental group and the control group was 19.7%（28/142） and 32.1%（45/140）,18.3%（26/142） and 40.7%（57/140） after operation,there was significant difference between the two groups （χ^2=5.077,6.606,P〈0.05）.The postoperative hospital stay,hospitalization expenses of the experimental group and the control group was （28.1±4.2） d and （45.6±3.9） d,￥（6 8174.7±3206.5） and￥（8 4774.8±4007.3） after operation,there was s

关 键 词：食管癌 食管胃交界部癌 纵隔橡皮引流管 吻合口瘘 

分 类 号：R735.1[医药卫生—肿瘤]