吻合口旁预置负压引流管治疗食管癌术后吻合口瘘的临床对比分析

目的:吻合口瘘是食管癌术后最严重的并发症。其治疗方法多样，具有广泛的争议。本研究旨在评估食管癌术中吻合口旁预置负压引流管治疗吻合口瘘的有效性及安全性。 方法：回顾性分析2008年1月至2014年1月我院68例食管癌、贲门癌术后胸腔内吻合口瘘的临床资料。根据治疗方法的不同将患者分为三组，即吻合口旁预置负压引流管组（A组）、内镜下经鼻瘘口置入引流管组（B组）、传统治疗组（C组）。 结果：食管癌、贲门癌根治术胸内吻合1251例，发生吻合口瘘68例（5.4%），死亡14例（20.5%）。A、B组与C组的死亡率有明显的统计学差异（P<0.05）。根据重复置管次数对比A、B两组均与C组有明显的统计学差异（P<0.05）。统计各组置管所需时间发现，A组吻合口旁预置负压引流管时间明显短于B、C两组（P<0.05）。统计各组患者瘘口引流冲洗时间、恢复时间及胃肠减压时间分析，可以发现A、B两组比C组所用时间大大缩短，有明显的统计学差异(P<0.05)。另外通过统计各组患者置管相关并发症可以发现，鼻咽部明显不适感及导管堵塞发生率，A、C两组明显少于B组，有明显的统计学差异(P<0.05)。除死亡患者外，各组吻合口瘘患者在经过积极治疗后均正常饮食，安全出院。 结论：吻合口旁预置负压引流管对胸腔吻合口瘘的治疗效果较好，可以明显缩短患者的恢复时间，降低患者的死亡率，减轻患者痛苦，是一种安全、有效的治疗方法。

Presetting negative pressure drainage for anastomotic leakage after esophageal cancer surgery: a clinical comparative analysis

Objective To evaluate the effectiveness and security of presetting negative pressure drainage for anastomotic leakage after esophageal cancer surgery. Methods Retrospective analysis of 68 patients with intrathoracic anastomotic leakage following surgery of esophageal and cardial carcinoma between January 2008 and January 2014. All the patients were divided into 3 groups,including presetting negative pressure drainage group(A group),endoscopy drainage placement group(B group)and traditional treatment group(C group). Results A total of 1251 patients underwent intrathoracic anastomosis were analyzed.Anastonotic leakage occurred in 68 cases(5.4%),of which 14 cases died after operation(20.5%).The difference in mortality among there groups was significant(p<0.05).A group and B group had less repeated drainage numbers than C group(p<0.05).Compared with B and C group,A group had advantage of less manipulation time(p<0.05).Drainage lavaging time, recovery time and retain time of gastric tube were reduced in A and B group(p<0.05).Patients had less discomfort in nasopharynx and obstruction incidence in A and C group than in B group. Conclusions Presetting negative pressure drainage after esophageal cancer surgery has a better effect on anastomotic leakage by reducing recovery time,lowering mortality and alleviating the suffering of patients. Our study suggests that it is both safe and effective.