Dai Lei, Tan Xiang, Chen Mingwu, Peng Huajian, Wang Yongyong
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Front Surg. 2024 Oct 2;11:1436176. doi: 10.3389/fsurg.2024.1436176. eCollection 2024.
Although mediastinal drainage may lower the risk of anastomotic leakage, the incident rate of anastomotic leakage is still high. The current study aimed to compare the effects of mediastinal drainage combined with upper mediastinal re-tunneling with mediastinal drainage only on anastomotic leakage after McKeown esophagectomy for esophageal cancer.
From October 2018 to March 2021, 52 patients diagnosed as esophageal carcinoma were included in the study. 21 patients received mediastinal drainage combined with upper mediastinal re-tunneling (re-tunneling group) and 31 received mediastinal drainage only (standard group) after McKeown esophagectomy. The incidence rate of anastomotic leakage, mediastinal infection, chylothorax, thoracic infection, the peak value of leukocyte count and the mortality related to anastomotic leakage were compared between the two groups.
One (4.8%) patient in the re-tunneling group developed anastomotic leakage, and no patient experienced mediastinal infection or thoracic infection. Four (12.9%) patients in the standard group developed anastomotic leakage, and all these patients experienced mediastinal infection and thoracic infection ( < 0.05). The drainage volumes of patients in the re-tunneling group and the standard group were (170 ± 60) ml and (155 ± 45) ml, respectively, with no significant difference between the two groups ( > 0.05). The peak values of leukocyte count and temperature in the re-tunneling group were (14.28 ± 1.12) × 10/L and (38.6 ± 1.1) °C, both lower than that of the standard group[ (16.48 ± 1.15) × 10/L and (38.9 ± 1.2) °C, respectively]. But the difference was not statistically significant ( > 0.05). No anastomotic leakage related death occurred in both groups.
Mediastinal drainage combined with upper mediastinal re-tunneling after McKeown esophagectomy for esophageal cancer may decrease the risk of anastomotic leakage, mediastinal and thoracic infection, reduce the inflammatory response of patients, but did not increase the mortality related to anastomotic leakage.
The study was retrospectively registered.
尽管纵隔引流可能降低吻合口漏的风险，但吻合口漏的发生率仍然很高。本研究旨在比较McKeown食管癌切除术后纵隔引流联合上纵隔再隧道化与单纯纵隔引流对吻合口漏的影响。
2018年10月至2021年3月，52例诊断为食管癌的患者纳入研究。21例患者在McKeown食管癌切除术后接受纵隔引流联合上纵隔再隧道化（再隧道化组），31例仅接受纵隔引流（标准组）。比较两组吻合口漏、纵隔感染、乳糜胸、胸腔感染的发生率、白细胞计数峰值以及与吻合口漏相关的死亡率。
再隧道化组1例（4.8%）患者发生吻合口漏，无患者发生纵隔感染或胸腔感染。标准组4例（12.9%）患者发生吻合口漏，所有这些患者均发生纵隔感染和胸腔感染（<0.05）。再隧道化组和标准组患者的引流量分别为（170±60）ml和（155±45）ml，两组间差异无统计学意义（>0.05）。再隧道化组白细胞计数峰值和体温分别为（14.28±1.12）×10/L和（38.6±1.1）℃，均低于标准组[分别为（16.48±1.15）×10/L和（38.9±1.2）℃]。但差异无统计学意义（>0.05）。两组均未发生与吻合口漏相关的死亡。
McKeown食管癌切除术后纵隔引流联合上纵隔再隧道化可能降低吻合口漏、纵隔和胸腔感染的风险，减轻患者的炎症反应，但未增加与吻合口漏相关的死亡率。
本研究为回顾性注册研究。
