双纵隔引流管在胸腔镜Ivor-Lewis术后胸内吻合口瘘老年患者中的应用  

Application of double mediastinal drainage tubes in elderly patients with intrathoracic anastomotic leak after thoracoscopic Ivor-Lewis surgery

作　　者：詹传飞 陈仕林[2] 沈晓康 冯冬杰[2] 王晓俊 沈伟忠[2] 蒋峰[2] 张勤[2] 许林[2] Zhan Chuanfei;Chen Shilin;Shen Xiaokang;Feng Dongjie;Wang Xiaojun;Shen Weizhong;Jiang Feng;Zhang Qin;Xu Lin(Critical Care Unit,Jiangsu Cancer Hospital,Nanjing 210009,China;Thoracic Surgery Department,Jiangsu Cancer Hospital,Nanjing 210009,China;Cardiothoracic Surgery Department,Nanjing First Hospital,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院重症医学科,南京210009 [2]江苏省肿瘤医院胸外科,南京210009 [3]南京市第一医院心胸外科,南京210009

出　　处：《中华老年医学杂志》2024年第1期56-59,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨全腔镜Ivor-Lewis术后吻合口瘘(AL)的老年患者术中预置双纵隔引流管的临床意义。方法回顾分析2020年1月至2022年12月,500例因食管癌或贲门癌行全腔镜Ivor-Lewis术老年患者的临床资料,按照术中引流管放置方式分为2组,对照组为单根纵隔引流管组,研究组为双纵隔引流管组,2组患者都常规置入胸管。比较两组患者术后1个月AL发生率,AL患者的炎症指标,AL的分级、鼻瘘管置入率、切口感染、吻合口狭窄、声音嘶哑发生率以及重症监护室(ICU)入住率、呼吸机使用时间及ICU住院时间。结果455例老年患者纳入了分析。研究组AL患者体温峰值[(39.58±1.03)℃和(38.05±0.56)℃,t=4.298,P<0.05)],白细胞计数峰值[(18.63±3.35)×109/L和(14.28±2.78)×109/L,t=3.450,P<0.05],C反应蛋白(CRP)峰值[(154.66±41.64)mg/L和(122.19±31.29)mg/L,t=2.131,P<0.05]低于对照组。研究组较对照组AL的分级和鼻瘘管置入率降低(82.4%和30.0%,χ^(2)=7.126,P<0.05)。在重症指标方面,研究组较对照组ICU入住率更低[64.7%和10.0%,χ^(2)=7.349,P<0.05),呼吸机使用时间(6.47±8.15)d和(0.90±2.23)d,t=2.62,P<0.05],ICU住院时间[(11.70±8.89)d和(4.70±6.27)d,t=2.184,P<0.05]也较对照组缩短。结论双纵隔引流管的应用可明显减轻炎症反应,降低老年患者鼻瘘管置入率,ICU入住率,缩短ICU住院时间,且相对安全,有一定的临床应用价值。ObjectiveTo investigate the clinical significance of intraoperative prepositioning of dual mediastinal drains in elderly patients developing anastomotic leakage(AL)after a total endoscopic Ivor-Lewis procedure.MethodsThis retrospective case-control study analyzed the clinical data of 500 elderly patients who underwent total endoscopic Ivor-Lewis surgery for esophageal or cardia cancer from January 2020 to December 2022.In the control group,one mediastinal drainage tube was placed intraoperatively,while in the study group,two mediastinal drainage tubes were placed.Both groups had a chest tube placed conventionally.The study compared the incidence of anastomotic leak(AL)at 1 month postoperatively,inflammatory indexes in patients with AL,grading of AL,rate of nasal fistula placement,incision infection,anastomotic stenosis,and incidence of hoarseness.Additionally,it compared ICU occupancy,ventilator use,and ICU length of stay between the two groups.ResultsThe analysis included clinical data from 455 elderly patients.Among the patients who developed AL,the study group had significantly lower peak body temperature[(39.58±1.03)℃vs.(38.05±0.56)℃,t=4.298,P<0.05],white blood cell count[(18.63±3.35)×109/L vs.(14.28±2.78)×109/L,t=3.450,P<0.05],and C-reactive protein(CRP)levels[(154.66±41.64)mg/L vs.(122.19±31.29)mg/L,t=2.131,P<0.05].The study group also had a significantly lower grading of AL and rate of nasal fistula placement(82.4%vs.30.0%,P<0.05).In terms of ICU indicators,the study group had a significantly lower ICU admission rate(64.7%vs.10.0%,P<0.05),shorter period of ventilator use[(6.47±8.15)days vs.(0.90±2.23)days,t=2.62,P<0.05],and shorter ICU stay[(11.70±8.89)days vs.(4.70±6.27)days,t=2.184,P<0.05].ConclusionsDouble mediastinal drainage tubes,have been found to significantly alleviate inflammation,decrease the rate of nasal fistula placement and ICU admission,and shorten the length of ICU stay in elderly patients.Therefore,they are considered safe and deserving of clinical promotion.

关 键 词：引流术 食管肿瘤 外科吻合口 瘘 

分 类 号：R735.1[医药卫生—肿瘤]