Kratz J M, Reed C E, Crawford F A, Stroud M R, Parker E F
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston 29425.
J Thorac Cardiovasc Surg. 1989 Jan;97(1):19-23.
We reviewed our use of endoesophageal tubes for the palliation of patients with carcinoma of the esophagus from 1973 through 1986. Celestin tubes were implanted by means of laparotomy and traction. Proctor-Livingston tubes were implanted by pulsion with frequent laparotomy for staging. All Atkinson tubes were placed by means of the pulsion method without simultaneous laparotomy in any case. Patients with an Atkinson tube had fewer complications, including aspiration, sepsis, reflux, and pneumonia. Mean hospital stay was shortened to 4 days when the Atkinson tube was used, and hospital death rate was 6% versus 42% when either the Celestin or Proctor-Livingston tube was used. Mean long-term survival (108 days) was significantly lengthened when Atkinson tubes were used. A comparison of all patients receiving tubes revealed a less frequent prevalence of reflux when the distal end of the tube was positioned above the gastroesophageal junction. Laparotomy resulted in significantly more episodes of aspiration, sepsis, reflux, and pneumonia. Laparotomy was also associated with a 41% hospital death rate versus 17% when laparotomy was not performed. Hospital days were shortened to 7 versus 16 days when laparotomy was not performed. The Atkinson tube provided improved palliation and decreased morbidity and mortality in our hands. These benefits were probably the results of ease of insertion without the use of a laparotomy and the ability in most cases to position the distal end of the tube above the gastroesophageal junction.
我们回顾了1973年至1986年期间我们使用食管内管为食管癌患者进行姑息治疗的情况。Celestin管通过剖腹术和牵引植入。Proctor-Livingston管通过脉冲法植入，且频繁进行剖腹术以进行分期。所有Atkinson管均通过脉冲法放置，在任何情况下均不同时进行剖腹术。使用Atkinson管的患者并发症较少，包括误吸、败血症、反流和肺炎。使用Atkinson管时，平均住院时间缩短至4天，医院死亡率为6%，而使用Celestin管或Proctor-Livingston管时为42%。使用Atkinson管时，平均长期生存率（108天）显著延长。对所有接受置管的患者进行比较发现，当管的远端位于胃食管交界处上方时，反流的发生率较低。剖腹术导致误吸、败血症、反流和肺炎的发作明显更多。剖腹术还与41%的医院死亡率相关，而未进行剖腹术时为17%。未进行剖腹术时，住院天数缩短至7天，而进行剖腹术时为16天。在我们手中，Atkinson管提供了更好的姑息治疗效果，并降低了发病率和死亡率。这些益处可能是由于无需剖腹术即可轻松插入，以及在大多数情况下能够将管的远端置于胃食管交界处上方的能力所致。
