新"三管"法治疗食管癌术后食管胃吻合口瘘的应用价值分析

目的 观察评价胸腔引流管为主的"三管"法和透视引导下经鼻置入瘘腔负压引流管为主的新"三管"法治疗食管癌术后食管胃吻合口瘘的近期治疗效果.方法 90例食管癌术后食管胃吻合口瘘患者随机分为对照组与观察组,每组各45例.对照组采用胸腔引流管为主的"三管"法治疗,观察组采用透视引导下经鼻置入瘘腔负压引流管为主的新"三管"法治疗.比较两组的平均住院时间、疼痛VAS评分、体力恢复状况、镇静评分等指标.结果 观察组患者平均住院时间为(27.41±10.23)d,明显低于对照组的(53.26±13.27)d,差异有统计学意义(t=9.005,P<0.0001);观察组的疼痛VAS评分、体力恢复状况评分分别为(2.70±1.47)分、(2.11±0.82)分,均明显低于对照组的(6.58±4.32)分、(3.87±1.98)分,差异有统计学意义(t=10.003,8.273;P<0.0001);两组镇静Ramsay评分比较差异无统计学意义(t=0.215,P=0.832);观察组病死率(4.44%)明显低于对照组(26.67%),治愈率(84.44%)明显高于对照组(51.11%),观察组的预后明显优于对照组,差异具有统计学意义(Z=3.498,P=0.000).结论 临床应用经鼻置入瘘腔负压引流管为主的新"三管"法治疗食管癌术后食管胃吻合口瘘,其操作较简单,可提高患者治愈率,缩短住院时间,缓解患者疼痛,促进体力恢复,值得进一步推广.

The value of new"three tubes"therapy in the treatment of esophagogastric anastomotic fistula after esophagectomy for esophageal carcinoma

Objective To observe and evaluate the short-term efficacy of chest tube-based"three tubes"therapy and the new"three tubes"using fluoroscopically-guided transnasal tube insertion in the treatment of esophagogastric anasto-motic fistula after esophagectomy for esophageal carcinoma. Method 90 patients with esophagogastric anastomotic fis-tula after esophagectomy for esophageal carcinoma were included in the study and randomized as control group and study group with 45 cases in each. The control group received chest tube-based"three tubes"therapy;And the study group was administered with fluoroscopically-guided transnasal tube insertion-based new"three tubes"therapy. The average hospital stay, VAS scores of pain, physical recovery, sedation scores and other indicators of the two groups were compared. Result The average time of hospital stay of the study group was (27.41±10.23) d, which was significantly shorter than that of the control group at (53.26 ± 13.27) d (t=9.005, P<0.0001);VAS scores of pain, and ZPS score was (2.70 ± 1.47) and (2.11 ± 0.82) in study group, and were significantly lower than those of the control group at (6.58±4.32) and (3.87±1.98), respec-tively (t=10.003, P<0.0001;t=8.273, P<0.0001);Ramsay sedation scores were similar between the two groups (t=0.215, P=0.832);While higher mortality rate (4.44%) was observed in study group compared with control group (26.67%), be-sides, the study group had higher cure rate (84.44%) than the control group (51.11%), with better prognosis (Z=3.498, P=0.000). Conclusion The clinical application of the new"three tubes"therapy with transnasal tube insertion is applicable and feasible in the treatment of esophagogastric anastomotic fistula after esophagectomy for esophageal carcinoma, with improved cure rate, less hospital stay, minor pain and accelerated recovery.