透视引导下经鼻置入瘘腔引流管治疗食管癌术后食管胃吻合口瘘

目的 回顾性分析并评价瘘腔引流管在治疗食管癌术后食管胃吻合口瘘中的价值.方法 2004年5月- 2010年9月共诊治食管贲门癌术后食管胃吻合口瘘78例.32例患者(Ⅰ组)采用胸腔引流管为主的"三管"法传统治疗,即透视下放置胃肠减压管,空肠营养管,术后常规放置胸腔引流管.46例患者(Ⅱ组)采用透视引导下经鼻瘘腔负压引流管置入为主的新"三管"法介入治疗,即透视引导下放置胃肠减压管,空肠营养管,瘘腔负压引流管.胸腔引流管在瘘腔引流管置放成功后即拔除.结果 所有患者均在DSA透视引导下一次置管成功,胸腔引流管在Ⅰ组患者术后常规置放,位置准确.Ⅰ组24例存活患者的瘘腔平均治疗时间为(54.6 ± 7.9) d;死亡8例,病死率为25.0%.而Ⅱ组44例存活患者的瘘腔平均治疗时间为(31.0 ± 8.1) d;死亡2例,病死率为4.3%.两组患者的瘘腔治疗时间比较差异有统计学意义(P ＜ 0.01).结论 DSA透视引导下留置胃肠减压管,空肠营养管,瘘腔引流管治疗食管癌术后胸内食管胃吻合口瘘安全,有效,经济.经鼻置入瘘腔引流管治疗食管癌术后食管胃吻合口瘘可明显缩短患者住院治疗时间,降低住院病死率.

Fluoroscopically-guided transnasal tube insertion for the treatment of gastroesophageal anastomotic leak occurred after surgery for esophageal carcinoma

Objective To retrospectively evaluate the therapeutic effect of fluoroscopically-guided transnasal tube insertion in treating gastroesophageal anastomotic leak occurred after the surgery for esophageal carcinoma.Methods During the period from May 2004 to Sep.2010,a total of 78 patients with gastroesophageal anastomotic leak(GEAL),which occurred after the surgery for esophageal carcinoma,were treated in authors’ hospital.Thirty-two patients(groupⅠ) were treated by "three-tube method",the three tubes included the nasogastric decompression tube,the nasojejunum enteral support tube and the thoracic drainage tube.Forty-six patients(groupⅡ) were treated with the fluoroscopically-guided transnasal placement of sump tube through the leak,the nasogastric decompression tube and the nasojejunum enteral support tube.The clinical results were compared between the two groups.Results The drainage tube of thoracic abscess,nutritious tube of jejunum,gastric decompression tube were successfully placed under the fluoroscopic guidance.The mean therapeutic time in the 24 survival patients of group I was(54.6±7.9) days.Four patients in groupⅠdied,the mortality was 25.0%.The mean therapeutic time in the 44 survival patients of groupⅡwas(31.0±8.1) days.Two patients in groupⅡdied,the mortality was 4.3%.Statistical significant difference in the mean therapeutic time existed between the two groups(P<0.01).Conclusion For the treatment of gastroesophageal anastomotic leak occurred after surgery for esophageal carcinoma,fluoroscopically-guided transnasal placement of nasogastric decompression tube, nasojejunum nutritious tube and sump tube through the leak is safe,effective and economical.This treatment can markedly shorten the hospitalization days and lower hospitalization mortality.