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目的:探讨纵隔引流管在防治经上腹右胸食管癌切除术后吻合口瘘中的临床意义。方法:2011年5月到2014年12月,我科一个治疗组共行经右胸上腹食管癌手术405例,同时术后单纯放置胸腔引流管(对照组)149例,同时放置纵隔引流管和胸腔引流管(研究组)256例,比较两组临床疗效。结果:两组吻合口瘘发生率差异无统计学意义(χ2=0.000,P>0.05);对照组吻合口瘘确诊平均时间(10.4±1.2)天,显著长于研究组(6.4±1.1)天(t=-4.010,P<0.05);对照组术后平均住院时间(37.8±9.6)天,显著长于研究组(18.2±1.6)天(t=-4.010,P<0.05);对照组发生吻合口瘘患者平均体温(38.7±0.5)℃,显著高于研究组(36.8±0.3)℃(t=8.162,P<0.05);对照组发生吻合口瘘患者平均白细胞计数(16.2±2.0)×109/L,显著高于研究组(6.4±1.8)×109/L(t=9.214,P<0.05);对照组发生吻合口瘘患者带管时间(35.0±7.2)天,显著长于研究组(17.6±0.9)天(t=5.335,P<0.05);对照组心律失常和肺部感染发生率与研究组差异无统计学意义(P>0.05)。结论:术中留置纵隔引流管能早期发现吻合口瘘,并有效地控制纵隔感染,避免二次开胸手术,缩短平均住院时间,降低吻合口瘘的病死率。
Objective: To investigate the clinical significance of mediastinal drainage tube in the prevention and treatment of anastomotic leakage after transabdominal esophagectomy. Methods: From May 2011 to December 2014, 405 patients in one treatment group underwent right thoracic esophagectomy and 149 patients in the control group were treated by simple placement of mediastinal drainage tube Thoracic drainage tube (study group) 256 cases, the clinical efficacy of two groups were compared. Results: There was no significant difference in the incidence of anastomotic fistula between the two groups (χ2 = 0.000, P> 0.05). The mean duration of anastomotic leakage in the control group was 10.4 ± 1.2 days, significantly longer than that of the study group (6.4 ± 1.1) days t = -4.010, P <0.05). The average postoperative hospital stay (37.8 ± 9.6) days in the control group was significantly longer than that in the study group (18.2 ± 1.6 days) (t = -4.010, P <0.05) The mean body temperature of patients with fistula (38.7 ± 0.5) ℃ was significantly higher than that of the study group (36.8 ± 0.3) ℃ (t = 8.162, P <0.05). The mean leukocyte count in the control group with anastomotic fistula was 16.2 ± 2.0 × 109 / L was significantly higher than that of the study group (6.4 ± 1.8) × 109 / L (t = 9.214, P <0.05). The control group had an anastomotic fistula of 35.0 ± 7.2 days, 0.9) days (t = 5.335, P <0.05). There was no significant difference in the incidence of arrhythmia and pulmonary infection between the control group and the study group (P> 0.05). Conclusion: Intraoperative indwelling mediastinal drainage tube can find anastomotic fistula early and effectively control mediastinal infection, avoid secondary thoracotomy, shorten the average hospital stay and reduce the mortality of anastomotic fistula.