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《Chinese Journal of Difficult and Complicated Cases》 2017-12
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Treatment of anastomosis leakage in resection of esophageal carcinoma with drainage in mediastinum

MA Yuefeng;XING Xin;KONG Ranran;MA Zhenchuan;SUN Liangzhang;ZHANG Wei;LI Shaomin;Department of Thoracic Surgery,the Second Affiliated Hospital of Medical College of Xi'an Jiaotong University;  
Objective To investigate the therapeutic effect of anastomosis leakage in resection of esophageal carcinoma with drainage in mediastinum. Methods Forty-five cases with esophageal carcinoma underwent radical operation( Sweet or Ivor lewis) suffered anastomosis leakage between January 2012 to December 2016 were retrospectively analyzed. There were 22 cases which were control group without mediastinal drainage tube and 23 cases which were study group with mediastinal drainage tube in original esophagus bed. The drainage was placed under the anastomosis of esophageal and gastric about 1. 0-2. 0 cm. We observed changes in a range of clinical indicators after surgery in the two groups. Result: All patients with anastomotic leakage were treated with positive treatment,32 cases cured and 13 cases died. The postoperative variations of the period of time which confirmed diagnosis of anastomotic leakage( t = 3. 834,P 0. 05),mean maximum temperature( t = 8. 965,P 0. 05),mean maximum leukocyte count( t = 6. 185,P 0. 05),the number of patients with hydrothorax of contralateral lung need to puncture and drainage( χ~2= 2. 522,P 0. 05),the number of patients which suffered cardiopulmonary complication( χ~2= 2. 741,P 0. 05),the fatality rate by anastomotic leakage( χ~2= 1. 755,P 0. 05),the period of time for recovery after anastomotic leakage( t = 11. 237,P 0. 05) were statistically significant in two groups. The number of patients which suffered anastomotic stenosis at 6 months need dilated after surgery were not statistically significant( χ~2= 0. 897,P 0. 05) in two groups. The volume of the mediastinal drainage tube( 536. 8 ± 108. 3) ml accounts for about 70% of the total volume of thoracic drainage( 753. 6 ± 136. 4) ml in study group. Conclusion Placing a esophageal bed mediastinal drainage tube in radical operation for esophagus cancer was valuable for early diagnosis and treatment of anastomotic leakage as well as shorting the recovery course of anastomotic leakage and reducing mortality caused by anastomotic leakage. It is worthwhile for clinical use. However,there was no obvious effect on postoperative anastomotic stenosis.
【CateGory Index】: R735.1
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