双腔冲洗引流管在食管癌术后复杂胸内吻合口漏中的应用效果
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摘要
目的探讨双腔冲洗引流管在复杂胸内漏中的应用效果。方法回顾性分析北京大学深圳医院2014年9月至2018年7月行食管癌根治术后复杂胸内吻合口漏的9例患者的临床资料,患者均放置双腔冲洗引流管,分析患者治疗效果、住院期间转归情况。结果患者均置管成功,治疗过程未出现急性呼吸窘迫综合征(ARDS)、感染性休克、败血症等严重并发症,均未行二次手术和气管插管。9例患者均治愈,无患者死亡,吻合口漏愈合天数为23~57 d,平均(36.1±10.8)d;体温恢复正常天数为1~16 d,平均(5.7±4.9)d;白细胞总数恢复正常天数为6~27 d,平均(11.7±7.3)d。结论双腔冲洗引流管在避免创伤基础上可有效消灭吻合口周围脓腔,减少并发症、住院时间和住院费用,降低病死率。
Objective To explore the application effect of double-chamber irrigation drainage tube in complicated intrathoracic anastomotic leakage after operation of esophageal cancer. Methods The clinical data of 9 patients with complicated intrathoracic anastomotic leakage after radical resection of esophageal cancer in Peking University Shenzhen Hospital from September 2014 to July 2018 were retrospectively analyzed. Double-chamber irrigation drainage tube was placed in all patients, and the treatment effect and prognosis during hospitalization of patients were analyzed. Results All patients were successfully in catheterization. There were no serious complications such as acute respiratory distress syndrome(ARDS), infectious shock and hematosepsis. No patients underwent secondary surgery or endotracheal intubation. All 9 patients were cured and no patients died. The healing days of anastomotic leakage ranged from 23-57 days, with an average of(36.1±10.8) days; the days of body temperature returning to normal ranged from 1-16 days, with an average of(5.7±4.9) days; and the days of total white blood cells returning to normal ranged from 6-27 days, with an average of(11.7±7.3) days. Conclusion Double-chamber irrigation drainage tube can effectively eliminate the perianastomotic abscess on the basis of avoiding trauma, reduce complications, hospitalization time and cost, and reduce mortality.
Objective To explore the application effect of double-chamber irrigation drainage tube in complicated intrathoracic anastomotic leakage after operation of esophageal cancer. Methods The clinical data of 9 patients with complicated intrathoracic anastomotic leakage after radical resection of esophageal cancer in Peking University Shenzhen Hospital from September 2014 to July 2018 were retrospectively analyzed. Double-chamber irrigation drainage tube was placed in all patients, and the treatment effect and prognosis during hospitalization of patients were analyzed. Results All patients were successfully in catheterization. There were no serious complications such as acute respiratory distress syndrome(ARDS), infectious shock and hematosepsis. No patients underwent secondary surgery or endotracheal intubation. All 9 patients were cured and no patients died. The healing days of anastomotic leakage ranged from 23-57 days, with an average of(36.1±10.8) days; the days of body temperature returning to normal ranged from 1-16 days, with an average of(5.7±4.9) days; and the days of total white blood cells returning to normal ranged from 6-27 days, with an average of(11.7±7.3) days. Conclusion Double-chamber irrigation drainage tube can effectively eliminate the perianastomotic abscess on the basis of avoiding trauma, reduce complications, hospitalization time and cost, and reduce mortality.
引文
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[11] LOW DE,KUPPUSAMY MK,ALDERSON D,et al.Benchmarking complications associated with esophagectomy[J].Ann Surg,2019,269(2):291-298.
[12] WHOOLEY B,LAW S,ALEXANDROU A,et al.Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer[J].Am J Surg,2001,181(3):198-203.
[2] MARTIN-RICHARD M,D魱AZ BEVERIDGE R,ARRAZUBI V,et al.SEOM Clinical Guideline for the diagnosis and treatment of esophageal cancer(2016)[J].Clin Transl Oncol,2016,18(12):1179-1186.
[3] RIZK NP,BACH PB,SCHRAG D,et al.The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma[J].J Am Coll Surg,2004,198(1):42-50.
[4] GRIMMINGER PP,GOENSE L,GOCKEL I,et al.Diagnosis, assessment, and management of surgical complications following esophagectomy[J].Ann N Y Acad Sci,2018,1434(1):254-273.
[5]邵令方,王其彰.新编食管外科学[M].石家庄:河北科学技术出版社,2002:669-670.
[6]李波.食管贲门癌术后吻合口瘘二次手术的临床探讨[J].中国临床研究,2011,24(6):516.
[7]赵澜涛,王永宏,陈建海,等.食管癌和贲门癌术后胸内吻合口瘘的诊疗探讨[J].实用医学杂志,2013,29(15):2581-2582.
[8]徐凯,谢宏亚,马海涛,等.胸腔内食管-胃吻合口瘘诊治新模式初步研究结果[J].中华外科杂志,2016,54(2):114-118.
[9] PAGE RD,SHACKCLOTH MJ,RUSSELL GN,et al.Surgical treatment of anastomotic leaks after oesophagectomy[J].Eur J Cardiothorac Surg,2005,27(2):337-343.
[10] DENT B,GRIFFIN SM,JONES R,et al.Management and outcomes of anastomotic leaks after oesophagectomy[J].Br J Surg,2016,103(8):1033-1038.
[11] LOW DE,KUPPUSAMY MK,ALDERSON D,et al.Benchmarking complications associated with esophagectomy[J].Ann Surg,2019,269(2):291-298.
[12] WHOOLEY B,LAW S,ALEXANDROU A,et al.Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer[J].Am J Surg,2001,181(3):198-203.