食管癌和贲门癌术后胸内吻合口瘘两种不同治疗方法疗效比较

目的比较两种不同食管癌、贲门癌切除术后胸内吻合口瘘治疗方法的疗效。方法回顾分析1999年6月至2008年6月间中国医学科学院肿瘤医院胸外科连续4515例食管癌、贲门癌切除、食管胃胸内吻合术后发生吻合瘘的71例患者的临床资料,并将再次全麻下开胸置引流的38例作为手术治疗组,而另外33例经局麻置引流的作为保守治疗组,比较和讨论两组的治疗结果。统计方法采用SPSS 13.0软件包中的χ2检验和t检验。结果手术治疗组治愈率为86.8%,保守治疗组治愈率为75.6%（P=0.228）。手术治疗组痊愈者平均住院时间52.7 d,保守治疗组为73.7 d（P=0.041）。手术治疗组痊愈患者的平均住院费用为11.6万元,保守治疗组为14.7万元（P=0.045）。结论食管癌、贲门癌切除术后胸内食管胃胸内吻合口瘘一旦确诊或高度怀疑后,尤其对于病情危重的早期瘘,应尽快再次开胸充分引流。

Comparison of two different approaches for treatment of intra-thoracic anastomotic leakage following resection of the carcinoma of esophagus and gastric cardia

Objective To compare two different approaches for treatment of intra-thoracic anastomostic leakage following resection of the carcinoma of exophagus and gastric cardia.Methods Clinical materials of 71 patients who developed intra-thoracic anastomotic leakage were evaluated retrospectively.These patients were among 4515 conseentive patients who received resection of the carcinoma of exophagus and gastric cardia at Department of Thoracic Surgery,Cancer Hospital CAMS ＆ PUMC,from the June,1999 to the June,2008 The 38 patients who received general anesthesin for chest drainage by thoracotomy through original incision constituted operative group.The other 33 patients who received local anesthesia for chest drainage by chest puncture con-tituted conservative group.The therapeutic results of two groups were compared.X^2 test and t test of SPSS 13.0 software were adopted for statistical analysis Results The cure rates of the operative group and conservative group were 86.9% and 75.6% respectively,P=0.228.The mean length of hopital stay of cured patients of the operative group and conservative group was 52.7 days and 73.7 days,respectively,P=0.041 The mean hospital expenditures of cured patients of the operative group and conservative group were 116 thousand yuan and 147 thousand Yuan,respectively,P=0.045.Conclusion Once intra-thoracic anastomotic leakage following resection of the carcinoma of csophagus and gastric cardia is diagnosed or highly suspected ,and urgent repeated thoracotomy is indicated for full drainage,especially for severe patients whose lekage developes in early postoperative period.