左胸径路食管癌术中留置右胸管术后防反流引流的临床意义  

The Clinical Significance of Postoperative Anti-reflux Drainage of Right Thoracic Tube Placed in Surgical Treatment through Left-sided Thoracotomy Route for Esophageal Carcinoma Patients

作　　者：林存红 

机构地区：[1]山东省泰安市肿瘤防治院,山东泰安271000

出　　处：《中国医学创新》2017年第28期10-14,共5页Medical Innovation of China

摘　　要：目的:针对左胸径路食管癌手术术中右侧纵隔胸膜部分切除致纵隔贯通,术中经左胸、纵隔予右胸管留置术后予防返流引流处理,探讨右胸防反流引流管引流的临床意义。方法:选取2010年1月-2015年10月110例左胸径路食管癌手术术中右侧纵隔胸膜部分切除双侧胸腔贯通病例随机分为两组,A组48例常规左胸单根胸管闭式引流,同时予右胸管经纵隔由左胸腔引出接防返流引流袋引流,B组62例常规左胸单根胸管闭式引流。术后主要观察记录两组胸腔引流量、右胸腔穿刺抽液比例、术后住院时间及术后低氧血症、肺部并发症、心律失常发生率、切口并发症发生率、吻合口瘘发生率、围术期死亡率。结果:A组术后在胸腔引流总量方面明显多于B组(t=5.6560,P<0.01),同时B组因右胸腔积液积存需右胸穿刺(或留置胸管)引流病例比例为20.9%(13/62),而A组无需作此处理;A组术后住院时间明显短于B组(t=2.2824,P<0.05);A组术后在低氧血症发生率、肺部并发症发生率、心律失常发生率方面明显低于B组(x^2=4.440、4.440、4.340,P<0.05);两组术后切口并发症发生率、吻合口瘘发生率、围术期死亡率方面比较差异均无统计学意义(x^2=0.090、0.064、0.288,P>0.05)。结论:经左胸径路食管癌手术术中双侧胸腔贯通病例,在常规左胸腔闭式引流的同时,左胸径路食管癌术中双侧胸腔贯通术中留置右胸腔引流管经纵隔由左胸腔引出接防返流引流袋引流,作为一项手术改进,虽不能降低吻合口瘘的发生率,但可以减少心肺并发症等食管癌常见主要术后并发症的发生,减少右胸穿刺(或置管)引流的可能,减轻患者痛苦,有利于患者术后恢复,缩短住院时间。防反流引流管护理安全、简便,患者依从性良好。Objective：To investigate the clinical significance of postoperative anti-reflux drainage of right thoracic tube placed through left thoracic trans-mediastinal channel in surgical treatment for esophageal carcinoma patients right sided mediastinal pleura partly resected in operation through left-sided thoracotomy route.Method：110 cases with esophageal carcinoma that right sided mediastinal pleura partly resected in operation through left-sided thoracotomy route were randomly divided into two groups,A group of 48 cases were given routinely closed drainage through single left thoracic cavity drainage tube,meanwhile drainage through anti-reflux drainage bag postoperative through right thoracic tube placed through left thoracic trans-mediastinal channel in surgery.B group of 62 cases were treated with routinely closed drainage through single left thoracic cavity drainage tube.The clinical data of two groups in the thoracic drainage volume,right thoracic puncture drainage ratio,hospitalization time,postoperative hypoxemia,pulmonary complications,arrhythmia incidence,incision complications,anastomotic fistula rate,and perioperative mortality were observed,recorded, and then comparative analyzed.Result： The total amount of thoracic drainage in A group was significantly more than B group（t=5.6560,P〈0.01）.At the same time,proportion of patients with right pleural effusion who needed right thoracic puncture （or indwelling chest tube） in B group was 20.9%（13/62）,but A group did not need to do this treatment.The postoperative hospital stay（t=2.2824,P〈0.05）,postoperative hypoxemia,pulmonary complications,arrhythmia incidence in A group were significantly shorter or lower than those of B group,the differences were statistically significant（χ2=4.440,4.440,4.340;P〈0.05）.There were no statistically significant in incision complications,anastomotic fistula rate and perioperative mortality between two groups（ 字2=0.090,0.064,0.288;P〉0.05）.Conclusion：As a surgical improvement treatment that

关 键 词：食管癌 外科手术 胸腔引流 防反流 并发症 

分 类 号：R735.1[医药卫生—肿瘤]