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目的回顾性分析并评价瘘腔引流管在治疗食管癌术后食管胃吻合口瘘中的价值。方法 2004年5月-2010年9月共诊治食管贲门癌术后食管胃吻合口瘘78例。32例患者(Ⅰ组)采用胸腔引流管为主的“三管”法传统治疗,即透视下放置胃肠减压管,空肠营养管,术后常规放置胸腔引流管。46例患者(Ⅱ组)采用透视引导下经鼻瘘腔负压引流管置入为主的新“三管”法介入治疗,即透视引导下放置胃肠减压管,空肠营养管,瘘腔负压引流管。胸腔引流管在瘘腔引流管置放成功后即拔除。结果所有患者均在DSA透视引导下一次置管成功,胸腔引流管在I组患者术后常规置放,位置准确。Ⅰ组24例存活患者的瘘腔平均治疗时间为(54.6±7.9)d;死亡8例,病死率为25.0%。而Ⅱ组44例存活患者的瘘腔平均治疗时间为(31.0±8.1)d;死亡2例,病死率为4.3%。两组患者的瘘腔治疗时间比较差异有统计学意义(P<0.01)。结论 DSA透视引导下留置胃肠减压管,空肠营养管,瘘腔引流管治疗食管癌术后胸内食管胃吻合口瘘安全,有效,经济。经鼻置入瘘腔引流管治疗食管癌术后食管胃吻合口瘘可明显缩短患者住院治疗时间,降低住院病死率。
Objective To retrospectively analyze and evaluate the value of fistula drainage tube in the treatment of esophageal and gastric anastomotic fistula after esophagectomy. Methods From May 2004 to September 2010, 78 cases of esophagogastric anastomotic fistula were treated. Thirty-two patients (group Ⅰ) were treated by the conventional “three-tube” method of thoracic drainage tube. The gastrointestinal decompression tube and jejunal feeding tube were put under fluoroscopy, and the thoracic drainage tube was placed after the operation. Forty-six patients (group Ⅱ) underwent transcatheter treatment of transvaginal nasal fistula drainage under the guidance of fluoroscopy. The new “three-tube” Fistula negative pressure drainage tube. Pleural drainage tube in the fistula drainage tube placed after the successful removal. Results All patients underwent DSA fluoroscopy under the guidance of a successful catheterization. The thoracic drainage tubes were routinely placed in group I patients with accurate location. The average treatment time of fistula in 24 survivors in group Ⅰ was (54.6 ± 7.9) days, and in 8 cases, the mortality rate was 25.0%. The average treatment time of fistula in 44 survivors in group Ⅱ was (31.0 ± 8.1) days, and 2 died, the mortality rate was 4.3%. The two groups of patients fistula treatment time difference was statistically significant (P <0.01). Conclusion DSA fluoroscopy guided indwelling gastrointestinal decompression tube, jejunal feeding tube and fistula drainage tube is safe, effective and economical for the treatment of esophageal and gastric anastomotic fistula after esophagectomy. Transnasal fistula drainage tube for esophageal cancer after esophageal anastomotic fistula can significantly shorten the hospitalization time and reduce hospital mortality.