食管癌Ivor-Lewis术中营养管置入新方法的评价

目的评价食管癌Ivor-Lewis术中新的鼻十二指肠营养管置入方法的临床效果。 方法收集内蒙古医科大学附属医院胸外科2013年1月—2016年12月期间单一手术组同一术者开展的食管中下段癌Ivor-Lewis术共117例，其中2015年3月前采用空肠造瘘术行肠内营养49例；2015年3月后采用新方法放置鼻十二指肠营养管68例，比较两组患者术中营养管置入所需时间、带管的舒适性，以及吻合口瘘、肺部感染、与营养管相关并发症的发生率。 结果117例患者均顺利置入营养管，1例采用鼻十二指肠管组患者置入失败。两组均无住院死亡病例。鼻十二指肠管组比空肠造瘘组操作时间明显缩短，差异有统计学意义(6.2±1.8)min vs(18.2±8.2)min，P<0.05]。鼻十二指肠管组患者的咽喉部不适发生率明显高于空肠造瘘组，差异有统计学意义(36.8% vs 16.3%，P<0.05)。两组患者在肺部感染、恶心呕吐、吻合口瘘发生率等方面比较，差异均无统计学意义(P>0.05)，且均未发生术后胃排空障碍和急性胃扩张。空肠造瘘组术后2例患者出现腹壁造瘘口渗液(1例最终因渗液多而拔除)，2例患者出现不全肠梗阻；鼻十二指肠管组术后1例患者因烦躁自己拔除了胃管、十二指肠营养管。 结论在食管癌Ivor-Lewis术中，应用鼻十二指肠营养管置入方法简便、创伤小、时间短、并发症少，具有良好的临床效果。

Evaluation of a New Method of Ivor-Lewis Intraoperative Nutrient Tube Placement in Patients with Esophageal Cancer

ObjectiveTo evaluate the clinical effects of a new method for the placement of feeding tubes in the treatment of esophageal cancer with Ivor-Lewis surgery. MethodsA total of 117 cases with esophageal cancer in the same surgery group from January 2013 to December 2016 were collected from Department of Thoracic Surgery, Affiliated Hospital of Inner Mongolia Medical University. Before March 2015, 49 cases of enteral nutrition were treated with jejunostomy. After that date, 68 cases were treated with the new method of Nose-Duodenal feeding tube placement. Tube-placement time, tube-carrying comfort, the incidence of anastomotic leakage, pulmonary infection, and complications related to the nutrition tube were compared. ResultsNutrition tube were successfully placed for 117 cases. One case with nose-duodenal feeding tube placement failed. There were no hospital deaths in the two groups. The duration of operation was significantly shorter in the nose-duodenal tube group than in the jejunostomy group (6.2±1.8) min vs (18.2±8.2) min, P<0.05]. The incidence of throat discomfort in patients with nose-duodenal tube was significantly higher than that in the jejunostomy group (36.8% vs 16.3%, P<0.05). There was no significant difference in the incidence of pulmonary infection, nausea and vomiting, and anastomotic leakage between the two groups (P>0.05). No postoperative gastric emptying and acute gastric dilatation occurred. Two patients in the jejunostomy group had abdominal wall fistula leakage (1 case was eventually extirpated due to multiple exudates), and 2 patients had incomplete intestinal obstruction; One patient in the nose-duodenal tube group had irritability after surgery. One patient pulled out the stomach tube and duodenal nutrition tube due to anxiety. ConclusionsIn the treatment of esophageal cancer, the use of nose-duodenal nutrition tube placement method is simple, less traumatic, shorter, with fewer complications and good clinical results.