CAJ | 학술논문

目的：探索术中放置纵膈引流管对食管癌术后胸内吻合口瘘的治疗作用。方法以术中常规放置纵膈引流管的中、下段食管手术患者134例为观察组，以同一医疗组以往完成的、术中未放置纵膈引流管的食管癌手术患者150例为对照组，比较两组患者吻合口瘘发生率、吻合口瘘患者死亡率、呼吸衰竭发生率、胸部手术切口感染率、中度以上发热（体温≥38℃）比例及持续时间、抗生素使用时间、吻合口瘘愈合时间以及住院时间。结果观察组吻合口瘘发生率为8．2％（11／134），对照组为6％（9／150），两组间无统计学差异（P＞0．05）；观察组吻合口瘘患者无死亡及呼吸衰竭病例，18．2％（2／11）合并胸部手术切口感染；对照组吻合口瘘患者死亡率、呼吸衰竭率和胸部手术切口感染率分别为33．3％（3／9）、44．4％（4／9）和77．8％（7／9），两组间均有统计学差异（P＜0．05）；观察组吻合口瘘患者中度以上发热比例为36．4％（4／11），持续时间2．3±1．2天，对照组吻合口瘘患者中度以上发热比例和持续时间分别为100％和8．6±2．3天，两组间均有统计学差异（P＜0．05）；观察组吻合口瘘患者术后抗生素平均使用时间、平均瘘口愈合时间、平均住院时间分别为9．6±3．2天、23．6±5．5天和22．6±5．7天，对照组吻合口瘘患者的抗生素平均使用时间、吻合口瘘愈合时间和住院时间分别为21．3±6．8天，38．3±8．4天和38．5±9．6天，两组间均有统计学差异（P＜0．05）。结论术中常规放置纵膈引流管并不能减少食管癌术后胸内吻合口瘘的发生，但能显著降低吻合口瘘患者的死亡率和呼吸衰竭发生率，并显著缩短感染持续时间和吻合口瘘的愈合时间。
목적：탐색술중방치종격인류관대식관암술후흉내문합구루적치료작용。방법이술중상규방치종격인류관적중、하단식관수술환자134례위관찰조，이동일의료조이왕완성적、술중미방치종격인류관적식관암수술환자150례위대조조，비교량조환자문합구루발생솔、문합구루환자사망솔、호흡쇠갈발생솔、흉부수술절구감염솔、중도이상발열（체온≥38℃）비례급지속시간、항생소사용시간、문합구루유합시간이급주원시간。결과관찰조문합구루발생솔위8．2％（11／134），대조조위6％（9／150），량조간무통계학차이（P＞0．05）；관찰조문합구루환자무사망급호흡쇠갈병례，18．2％（2／11）합병흉부수술절구감염；대조조문합구루환자사망솔、호흡쇠갈솔화흉부수술절구감염솔분별위33．3％（3／9）、44．4％（4／9）화77．8％（7／9），량조간균유통계학차이（P＜0．05）；관찰조문합구루환자중도이상발열비례위36．4％（4／11），지속시간2．3±1．2천，대조조문합구루환자중도이상발열비례화지속시간분별위100％화8．6±2．3천，량조간균유통계학차이（P＜0．05）；관찰조문합구루환자술후항생소평균사용시간、평균루구유합시간、평균주원시간분별위9．6±3．2천、23．6±5．5천화22．6±5．7천，대조조문합구루환자적항생소평균사용시간、문합구루유합시간화주원시간분별위21．3±6．8천，38．3±8．4천화38．5±9．6천，량조간균유통계학차이（P＜0．05）。결론술중상규방치종격인류관병불능감소식관암술후흉내문합구루적발생，단능현저강저문합구루환자적사망솔화호흡쇠갈발생솔，병현저축단감염지속시간화문합구루적유합시간。
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 e-sophageal cancer patients underwent esophagectomy and a mediastinal drainage tube was routinely placed intro -operatively ( observation group ) .Other 150 esophageal cancer patients underwent esophagectomy without mediasti -nal drainage were retrospectively set as control group .The following factors in the two groups were compared:in-cidence of anastomotic leak,and mortality rate,incidence of respiratory failure,incisional infection,rate and dura-tion 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 observa-tion 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 obser-vation 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 anasto-motic 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 anas -tomotic leak and shorten the duration of leak healing .