Tian Jieyong, Mei Xinyu, Guo Mingfa, Xiong Ran, Sun Xiangxiang
Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, Anhui, China.
J Cardiothorac Surg. 2020 Jun 17;15(1):142. doi: 10.1186/s13019-020-01162-7.
Although jejunostomy is widely used in complete thoracoscopic and laparoscopic minimally invasive Ivor-Lewis esophagectomy, its clinical effectiveness remains undefined. This study aimed to assess the therapeutic and side effects of jejunostomy in patients undergoing Ivor-Lewis esophagectomy for thoracic segment esophageal carcinoma.
A total of 1400 patients with esophageal carcinoma who underwent minimally invasive esophagectomy in the Thoracic Surgery of our hospital from 2015 to 2018 were retrospectively evaluated. Of these, 356 and 1044 were treated with nasojejunal feeding tubes (Nasojejunal group) and by jejunostomy (Jejunostomy group), respectively. Clinicopathologic factors, postoperative complications and tubule-related complications between the two groups were compared.
Both groups were well-balanced for clinicopathological data, except tumor location, which was significantly different (P < 0.001). Operation time (208.8 ± 53.5 min vs. 218.1 ± 43.2 min) was shorter in the Jejunostomy group compared with the Nasojejunal group, while intraoperative (26.6 ± 10.4 min vs 18.4 ± 9.1 min) and postoperative (38.6 ± 6.9 min vs 18.5 ± 7.6 min) indwelling times of nutrition tubes were prolonged (all P < 0.05). Postoperative pulmonary infection (17.0% vs 22.2%), incision infection (0.2% vs 1.1%), nutrient tube slippage (0.2% vs 5.1%) and nutrient reflux 1 (0.1% vs 5.6%) rates were reduced in the Jejunostomy group compared with the Nasojejunal group (P < 0.05). Meanwhile, ileus rates perioperatively (1.7% vs 0.3%) and at 3 postoperative months (1.7% vs 0.3%) were both higher in the Jejunostomy group compared with the Nasojejunal group.
Jejunostomy is a reliable enteral nutrition method in Ivor-Lewis esophagectomy for thoracic segment esophageal carcinoma.
尽管空肠造口术在完全胸腔镜和腹腔镜微创Ivor-Lewis食管癌切除术中广泛应用，但其临床疗效仍不明确。本研究旨在评估空肠造口术在接受Ivor-Lewis食管癌切除术治疗胸段食管癌患者中的治疗效果及副作用。
回顾性评估2015年至2018年在我院胸外科接受微创食管癌切除术的1400例食管癌患者。其中，分别有356例和1044例接受鼻空肠营养管治疗（鼻空肠组）和空肠造口术治疗（空肠造口术组）。比较两组的临床病理因素、术后并发症及与营养管相关的并发症。
除肿瘤位置差异有统计学意义（P＜0.001）外，两组临床病理数据均衡。空肠造口术组手术时间（208.8±53.5分钟 vs. 218.1±43.2分钟）较鼻空肠组短，而营养管术中留置时间（26.6±10.4分钟 vs 18.4±9.1分钟）和术后留置时间（38.6±6.9分钟 vs 18.5±7.6分钟）延长（均P＜0.05）。与鼻空肠组相比，空肠造口术组术后肺部感染率（17.0% vs 22.2%）、切口感染率（0.2% vs 1.1%）、营养管滑脱率（0.2% vs 5.1%）和营养反流率（0.1% vs 5.6%）降低（P＜0.05）。同时，空肠造口术组围手术期肠梗阻发生率（1.7% vs 0.3%）和术后3个月肠梗阻发生率（1.7% vs 0.3%）均高于鼻空肠组。
空肠造口术是Ivor-Lewis食管癌切除术治疗胸段食管癌可靠的肠内营养方法。
