关键词: 食管癌, 吻合口瘘, 纵膈引流, 胸腔感染

Abstract:

Objective To explore the effect of mediastinal drainage on the treatment for intra-thoracic anastomotic leak in esophageal cancer patients after esophagectomy.Methods One hundred and thirty-four esophageal cancer patients underwent esophagectomy and a mediastinal drainage tube was routinely placed intro-operatively(observation group).Other 150 esophageal cancer patients underwent esophagectomy without mediastinal drainage were retrospectively set as control group.The following factors in the two groups were compared: incidence of anastomotic leak,and mortality rate,incidence of respiratory failure,incisional infection,rate and duration of moderate or high fever(T≥38℃),duration of antibiotic use,duration of anastomotic leak healing and length of hospital stay of anastomotic leak patients.Results There was no significant difference in incidence rate of anastomotic leak between observation and control groups.There was no death,no respiratory failure in observation group;rate of chest incisional infection in observation group was 18.2%(2/11).Mortality rate,respiratory failure rate and chest incisional infection rate in control group were 33.3%(3/9)、44.4%(4/9)and 77.8%(7/9)respectively.Incidence and duration of moderate or high fever(36.4% and 2.3±1.2d respectively)in observation group were significantly lower than those in control group(100 % and 8.6±2.3d respectively)(P＜0.05).Duration of antibiotic use,duration of leak healing and length of hospitalization(9.6±3.2d,23.6±5.5d and 22.6±5.7d respectively)were significantly shorter than those in control group(21.3±6.8d,38.3±8.4d and 38.5±9.6d,P＜0.05)respectively).Conclusion Although mediastinal drainage could not prevent anastomotic leak in patients underwent esophagectomy,it could definitely decrease death and respiratory failure resulted from anastomotic leak.Mediastinal drainage could also decrease severity of intrathoracic infection caused by anastomotic leak and shorten the duration of leak healing.

Key words: Esophageal cancer, Anastomotic leak, Mediastinal drainage, Intra-thoracic infection