Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.
Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China.
J Cardiothorac Surg. 2021 Mar 25;16(1):52. doi: 10.1186/s13019-021-01435-9.
Intrathoracic esophageal anastomotic leakage (AL) is one of the most fatal complications after esophagectomy. In this study, we placed an additional drainage tube in the esophagus bed and evaluated its effect in early diagnosis and treatment of AL.
From January 2010 to August 2020, 312 patients with esophageal or cardia carcinoma underwent esophageal resection with intrathoracic esophagogastric anastomosis. A total of 138 patients with only one pleural drainage tube were divided into the "Control Group" and 174 patients with a pleural drainage tube and an additional mediastinal drainage tube (MDT) were divided into the "Tube Group". For all patients, the incidence of postoperative AL, the time to diagnosis, time to recovery, and patient outcome were analyzed.
No significant differences were observed in the AL rate (P = 0.837) and postoperative pain between two groups. However, in the Tube Group, almost all the patients were diagnosed prior to the appearance of hyperpyrexia, which was considered as the earliest and most common symptom after AL. In the Tube Group, a significant decrease was observed in the incidence of incurable fistula, which required re-operation or variable treatments under gastroscopy when compared to the Control Group (P = 0.032). Finally, patients in the Tube Group showed reduced post AL hospital day (P = 0.015) and a lower mortality, however, when compared to the Control Group, no significant differences were observed (P = 0.188).
Placement of an MDT does not prevent AL, but it is an effective approach for earlier diagnosis of AL and facilitates fistula healing and patient recovery.
胸内食管吻合口瘘（AL）是食管癌手术后最致命的并发症之一。在本研究中，我们在食管床中放置了一根额外的引流管，并评估了其在 AL 的早期诊断和治疗中的效果。
从 2010 年 1 月至 2020 年 8 月，312 例食管癌或贲门癌患者接受了经胸食管胃吻合术。共有 138 例仅放置了一根胸腔引流管的患者被分为“对照组”，174 例放置了胸腔引流管和纵隔引流管（MDT）的患者被分为“置管组”。所有患者均分析了术后 AL 的发生率、诊断时间、愈合时间和患者结局。
两组间的术后 AL 发生率（P=0.837）和术后疼痛无显著差异。然而，在置管组中，几乎所有患者在高热出现之前就被诊断出来，高热被认为是 AL 后最早和最常见的症状。与对照组相比，置管组中无法治愈的瘘管发生率显著降低，需要再次手术或经胃镜进行不同的治疗（P=0.032）。最后，置管组患者的术后 AL 住院天数（P=0.015）和死亡率均有所减少，但与对照组相比，无显著差异（P=0.188）。
放置 MDT 并不能预防 AL，但它是 AL 早期诊断的有效方法，并有助于瘘管愈合和患者康复。
