纵隔引流管在诊治食管癌术后吻合口瘘中的临床意义

目的：探讨纵隔引流管在食管癌术后吻合口瘘诊治中的临床意义。方法分析61例食管癌切除术后出现吻合口瘘的患者的资料,于术中常规放置胸管加放纵隔引流管的28例被设为引流组,仅常规放置胸管的另外33例被设为对照组。比较两组确诊吻合口瘘的时间、发热持续时间、继发肺部感染的发病率、住院日数以及预后等情况。结果引流组确诊吻合口瘘的时间为术后（6.2±0.5）d,短于对照组的（10.7±2.3）d （P ＜0.05）;引流组发热持续时间为（7.2±1.5）h,短于对照组的（45.3±18.5）h （P ＜0.01）。引流组与对照组吻合口瘘后继发肺部感染的发病率分别为18％和42％（P ＜0.05）。引流组经保守治疗后全部痊愈出院,术后住院日数为（24.5±5.6）d;对照组1例死于肺部感染,其余患者均痊愈出院,术后住院日数为（43.5±5.8）d ,明显长于引流组（P ＜0.05）。结论食管癌术中留置纵隔引流管有利于早期诊治吻合口瘘,减低继发肺部感染的发病率,缩短患者住院时间,改善预后。     

胸内食管吻合口瘘的治疗体会

我院自1984年以来共收治食管贲门癌273例,发生胸内食管吻合口瘘7例,发生率为2.6％,治愈3例,自动出院2例,治愈率为60％,死亡2例,死亡率为28.6％。 1 临床资料 7例胸内食管吻合口瘘中,男5例,女2例,60岁以上4例,弓上吻合5例,弓下吻合2例。瘘发现在术后6～12天5例,16天1例,20天1例,均根据临床     

纵隔引流管对食管癌术后吻合口瘘、心肺并发症的临床意义

目的探讨纵隔引流管防治食管癌切除术术后吻合口瘘、心肺并发症的临床意义。方法回顾性分析2009年至2011年160例食管癌患者（研究组）手术中放置纵隔引流管对术后吻合口瘘、心肺并发症的影响;同期选择2007年至2009年的158例食管癌手术患者（对照组）作对照比较。结果研究组和对照组术后吻合口痿发生率分别为3．1％（5／160）和3．8％（6／158）,差异无统计学意义（P〉0．05）;术后肺部感染发生率分别为12．5％（20／160）和25．6％（41／158）,心脏并发症发生率为16．9％（27／160）和35．4％（56／158）,差异均有统计学意义（P〈0．05）。对照组中大于60岁和有合并症的患者术后心肺并发症发生率与≤60岁和无合并症比较差异均有统计学意义（P〈0．05）;但是对照组中患者心肺并发症发生率在性别、肿瘤部位、TNM分期及切口类型中比较差异均无统计学意义（P〉0．05）。结论术中放置纵隔引流管虽然不能降低食管癌切除术术后吻合口瘘的发生率,但是有助于减少心肺并发症的发生,特别是对高龄或具有心肺基础疾病的患者。     

食管-胃胸内吻合口瘘防治现状

食管、贲门癌为常见恶性肿瘤,以手术为主的多学科综合治疗是其主要治疗措施。食管、贲门癌切除术后食管-胃胸内吻合口瘘是严重并发症之一。合理围手术期管理、精确手术技巧、术中实施预防措施可减少吻合口瘘,充分引流、营养支持、有效抗生素应用、禁食、胃肠减压、防治心肺并发症、及早闭合瘘口为其治疗基本原则。食管覆膜支架植入已大量应用于临床,成为其治疗发展的亮点。     

食管胃胸内器械吻合连续无吻合口瘘142例分析

食管癌、贲门癌切除术后发生食管胃吻合口瘘是严重的外科并发症。2001年1月～2004年11月，我科共行食管癌、贲门癌手术165例(手术切除162例，贲门癌3例手术探查)；食管胃颈部吻合13例，胸内手工吻合7例，胸内器械吻合142例；其中食管胃胸内器械吻合无吻合口瘘。现报告如下。     

食管贲门癌术后胸内吻合口瘘的护理

总结11例食管贲门癌术后胸内吻合口瘘患者的护理。护理重点为重视病情观察,及早发现吻合口漏,加强呼吸道护理、胸腔闭式引流护理、胃肠减压护理,重视营养支持及控制感染等。经治疗和护理,11例均临床治愈出院。     

瘘腔引流管治疗食管癌术后食管胃吻合口瘘的疗效

目的探讨食管癌手术后出现食管胃吻合瘘症状的患者采用瘘腔引流管方案治疗的疗效。方法将80例食管癌手术后出现食管胃吻合瘘症状的患者,根据引流治疗方案的不同分为2组,每组40例。对照组采取常规的三管引流方案对胃食管的吻合口瘘症状进行治疗;观察组采用瘘腔引流方案进行治疗。对2组患者吻合口瘘痊愈所用的时间、口瘘痊愈率及病死率进行比较。结果观察组吻合口瘘痊愈率、吻合口瘘痊愈所使用的时间及病死率分别为92.5%、(27.7±8.1)h及7.5%,对照组吻合口瘘痊愈率、吻合口瘘痊愈所使用的时间及病死率分别为75.0%、(51.4±5.8)h及12.5%,观察组吻合口瘘痊愈率明显高于对照组、吻合口痊愈所用的时间显著短于对照组、病死率低于对照组(均P<0.05)。结论利用瘘腔引流管仪器对手术后并发吻合口瘘的食管癌患者进行救治,可取得较理想的救治结果。     

超声引导置管引流在直肠癌术后引流管拔除后吻合口漏中的应用

目的探讨超声引导下经臀部骶骨旁入路置管引流在直肠癌术后引流管拔除后吻合口漏中的临床应用价值。 方法收集2015年1月至2019年12月浙江省肿瘤医院直肠癌术后引流管拔除后出现吻合口漏的23例患者的临床资料,选择经臀部骶骨旁入路置管引流治疗吻合口漏,观察该路径的可行性、置管成功率、并发症情况以及疗效。 结果23例患者共23个吻合口漏,发生在术后6~10 d,中位时间7 d。21例（91.3,21/23）患者CT检查显示骶前吻合口周围可见包裹性积液,存在置管路径,均置管成功,未出现置管相关并发症。置管后5~12 d拔管,中位时间7 d,所有患者均未出现吻合口漏复发。2例（8.7%,2/23）患者CT检查提示吻合口周围积液散在,超声检查显示无成片液性区,选择手术治疗。 结论对于直肠癌术后引流管拔除后出现的吻合口漏,当CT检查于骶前吻合口周围发现包裹性积液时,选择超声引导下经臀部骶骨旁入路置管引流,安全性高,有效率高,避免了二次手术。     

Endoscopic salvage treatment of histoacryl after stent application on the anastomotic leak after gastrectomy: A case report

BACKGROUNDEndoscopic approach could effectively manage postoperative anastomotic leakage. Various endoscopic methods have been developed for the treatment of anastomotic leakage.CASE SUMMARYA 53-year-old woman developed anastomotic leak after laparoscopic proximal gastrectomy. Endoscopic clip closure failed due to strong wall tension; therefore, a fully covered self-expandable esophageal metal stent (fc-SEMS) was placed to cover the leak after it was filled with a mixture of fibrin glue and histoacryl. However, fluoroscopy with gastrograffin showed dye leaking out of the fc-SEMS. Using the previous fluoroscopic image for guidance, a catheter was inserted at the leakage site. The radiocontrast dye was injected and was seen spreading along the sinus tract. Thereafter, histoacryl was injected. Seven days after the last procedure, upper gastrointestinal contrast studies showed no leaks. The patient was subsequently discharged 9 d after histoacryl injection without any complications.CONCLUSIONTo seal an anastomosis leak after stent application, salvage technique using histoacryl injection at the leakage site with fluoroscopy guidance could be considered cautiously.     

Procalcitonin,as an early biomarker of colorectal anastomotic leak,facilitates enhanced recovery after surgery

Purpose

Procalcitonin (PCT) is a biomarker used to help sepsis diagnosing and monitoring and guide antibiotic therapy. Anastomotic leak (AL) after colorectal surgery is a severe complication associated with relevant short- and long-term sequelae. The aim of our study is to assess the predictive value of PCT levels to early diagnose AL after colorectal surgery.

Methods

Between September 2011 and September 2012, a series of 99 patients underwent colorectal surgery in our institution. In all cases, white blood cell (WBC) count, C-reactive protein (CRP), and PCT levels were measured in first, third, and fifth postoperative day (POD). Anastomotic leaks and all other postoperative complications were recorded.

Results

We registered 7 ALs (7.1%). Decreased PCT levels had a significant negative predictive value (NPV) for AL in third and fifth POD (96.7% and 96.7%, respectively), compared with CRP and WBC. The best diagnostic performance was obtained with the combination of PCT and CRP measurements in third and fifth POD (area under the curve, 0.87 and 0.94, respectively). In 5th POD, PCT improves diagnosis, but not in a statistically significant way (area under the curve, 0.86).

Conclusions

Compared with more established biochemical values such as CRP and WBC, PCT is an earlier, more sensitive, and reliable marker of AL. Increased PCT levels in early PODs after colorectal surgery may provide a more effective way to detect AL, before clinical symptoms appear. Moreover, normal PCT values might be also a useful marker to facilitate a safe and early discharge of selected patients after colorectal surgery.     

Bentall术后冠状动脉吻合口漏的超声心动图特征

目的探讨Bentall术后冠状动脉吻合口漏的超声心动图特征,分析其诊断要点。 方法选取2017年1月至2018年12月北京安贞医院收治,经超声诊断为Bentall术后冠状动脉吻合口漏且经CT血管造影（CTA）证实的患者38例,对其超声心动图结果进行回顾性分析,总结冠状动脉吻合口漏的声像图特征。 结果冠状动脉吻合口漏的超声心动图结果主要表现为以下特征：冠状动脉吻合口处可见回声中断,缺口直径大小平均为（3.2±1.5）mm;吻合口处可探及彩色血流信号并可测得高速连续湍流频谱,峰值速度平均为（349±108）cm/s;人工血管与自体血管间可见分离暗区,分离宽度平均为（11.9±10.1）mm;部分患者（4/38,10.5%）可见异常血流信号经主动脉分流至右心房。 结论超声心动图可对Bentall术后冠状动脉吻合口漏病变做出明确诊断,并可准确反映吻合口漏的大小、数目、血流等信息,为临床决策提供重要依据。     

Is retention of a nasogastric tube after esophagectomy a risk factor for postoperative respiratory tract infection?

Between 1990 and 2004, 149 patients underwent esophagectomy with thoracotomy at our institution. Because the retention of a nasogastric tube postoperatively impedes expectoration, this practice was abolished in 1997, in order to reduce the risk of respiratory tract infection (RTI). Since 1998, we have instead performed gastrostomy for decompression. In this retrospective study, we compared the incidence of postoperative respiratory tract infection between these two groups. We previously demonstrated that the concordance between bacteria detected in the gastric juices and those detected in sputum was more than 70% in patients with postoperative RTI. In the present study, the incidence of postoperative respiratory tract infection was significantly higher in patients in whom a nasogastric tube was retained when compared to the rate in those for whom gastrostomy was performed instead (41.5% [34/82] vs 26.9% [18/67]; P = 0.045). The rate of other infections did not differ significantly between the two groups. We conclude that, in the postoperative management of esophagectomy, the retention of a nasogastric tube impedes expectoration. In addition, nasogastric tubes appear to increase the risk of postoperative RTI, considering the previous finding that the concordance of bacteria in sputum and gastric secretion was over 70%.     

Bentall术后冠状动脉吻合口漏并假性动脉瘤形成的超声诊断价值

目的 探讨二维及彩色多普勒超声在Bentall术后冠状动脉吻合口漏并假性动脉瘤形成诊断中的应用价值。方法 对本院16例Bentall术后临床诊断为冠脉动脉吻合口漏并假性动脉瘤形成患者的二维超声及彩色多普勒超声征像进行总结,并与主动脉造影结果进行对比分析。结果 16例患者人工血管周围二维超声均可探及搏动性无回声区,冠状动脉吻合口处彩色多普勒可显示异常血流信号,其中左侧9例,右侧7例。所有超声结果均与主动脉造影结果一致。结论 超声心动图可以及时、准确、无创诊断Bentall术后冠脉吻合口漏及并发的假性动脉瘤,可作为临床随访检查的首选方法。     

中下段食管癌根治术后胸内吻合口瘘的治疗体会

目的 观察运用手术和保守方法治疗中下段食管癌根治术后胸内吻合口瘘的临床疗效.方法 选取1995年1月至2011年12月食管癌根治术后胸内吻合口瘘患者43例,按照治疗方法不同分为手术组(22例)和保守组(21例).观察两组的转归、ICU监护时间、发热持续时间、胃肠减压时间、胸腔闭式引流时间、平均住院时间和平均住院费用.结果 手术组的治愈率、病死率分别为86.7%和5.3%,与保守组的77.9%和7.9%比较,差异无统计学意义(P>0.05).手术组的ICU监护时间、发热持续时间、胃肠减压时间、胸腔闭式引流时间、平均住院时间和平均住院费用较保守组明显缩短或者降低,差异有统计学意义(P<0.05或<0.01).结论 对于中下段食管癌根治术后胸内吻合口瘘,一旦发现,建议手术治疗,对改善患者的症状和节省医疗费用具有重要意义.     

细节护理在开胸术后留置胸腔引流管患者中的应用

目的：探讨细节护理在开胸术后留置胸腔引流管患者中的应用效果,以便更好地为患者服务。方法2010年11月-2012年12月共收治开胸手术留置胸腔引流管的患者120例,采用随机数字表法分为对照组和观察组,每组60例。对照组采用常规护理,观察组在常规护理的基础上采用细节护理。比较两组患者的护理满意度和胸腔引流管的平均留置时间。结果两组患者满意度情况比较,观察组患者满意度为（98．37±1．54）分,优于对照组的（81．26±1．72）分,差异有统计学意义（t＝4．980, P＜0．05）。两组患者胸腔引流管的留置时间比较,观察组的平均留置时间为（73．47±1．58） h,短于对照组的（95．24±2．67）h,差异有统计学意义（t＝5．697,P＜0．05）。结论细节护理能够有效降低开胸手术患者的胸腔引流管平均留置时间,提高患者的满意度。