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。

Significance of mediastinum drainage tube in anastomotic stoma leak and cardiopulmonary complication after resection of esophageal carcinoma.

Objective To explore the significance of mediastinum drainage tube in prevention and treatment of anastomotic stoma leak and cardiopulmonary complication after esophagectomy. Methods The incidence of postoperative anastomotic stoma leak and cardiopulmonary compli- cation in 160 esophageal carcinoma patients with mediastinum drainage tube placement （study group） during esophagectomy from 2009 to 2011 were compared with 158 esophageal carcinoma patients who underwent same Operation from 2007 to 2009 but without mediastinum drainage tube （ control group）. Results The incidence of anastomotic stoma leak was 3.1% （5/160） in study group, and 3.8 % （6/158） in control group （ P 〉 O. 05）. The incidences of pulmonary infection and cardiac complication were respectively 12.5% （20/160） and 16.9% （27/160） in study group; while they were 25.6% （41/158） and 35.4% （56/158） in control group. There were significant differences between two groups in the two indexes （ P 〈 O. 05 ）. In control group, the incidence of cardiopulmonary complication after esophagectomy was significantly higher in patients with comorbidity and older than 60 years, compared with those without comorbidity and less than or equal to 60 years （ P 〈 0.05 ）. However no difference in the incidence of cardiopulmonary complication was found when different gender, tumor location, incisional type and TNM stage were compared （ P 〉 0.05 ）. Conclusion Although the mediastinum drainage tube used in esophagectomy is not associated with the occurrence of anastomotic stoma leak, it can help to reduce the occurrence of cardiopulmonary complication, especially for senile patients or patients with heart and lung diseases.