内引流治疗胸内胃食管吻合口瘘的临床疗效观察
发布时间：2018-11-22 08:07
【摘要】：目的:探讨内镜下置管内引流治疗胸内胃食管吻合口瘘的临床疗效。方法:回顾性分析自2010年1月至2016年1月期间在青州市人民医院及益都中心医院治疗的50例胸内胃食管吻合口瘘患者,50例患者均通过口服亚甲蓝、上消化道碘油造影和胃镜检查来进行诊断及确诊,均符合食管癌、贲门癌术后胸内食管-胃吻合口瘘,但必须排除以下情况:食管癌及贲门癌患者手术后出现严重的肺部感染或乳糜胸者。将所选50例患者随机分为对照组和治疗组,对照组23例患者,治疗组27例患者。对照组:男性:15例,女性8例;年龄41-77岁,平均年龄(53.20?1.36)岁;食管癌16例,贲门癌7例。治疗组:男性16例,女性11例;年龄42-76岁,平均年龄(52.83?1.27)岁;食管癌21例,贲门癌6例。所选择的患者在手术方式、一般情况等方面基本相同,差异不显著(P0.05)。两组患者均给予通畅引流、静脉营养、胃肠减压及抗生素抗感染等一般保守治疗,治疗组患者在以上保守治疗基础上加用内镜下置管内引流治疗,并且每日用生理盐水反复进行冲洗,最后注入敏感抗生素。同时,随着瘘口周围脓腔逐渐缩小,逐步将引流导管外退。最后,直到每日抽出渗出液少于5ml,颜色清亮,无明显脓液及絮状物,在胃镜直视下,拔出硅胶导管,吻合口瘘口的内口在胃镜直视下予以钛夹夹闭或喷洒OB胶封堵。观察两组患者的内引流等置管时间、瘘口闭合时间、食管-胃吻合口瘘的临床治愈率及患者的并发症发生率,比较两组患者的临床治疗效果、住院治疗时间、费用及医疗满意度等。结果:治疗组患者的吻合口瘘口闭合时间及带管时间明显短于实验组的患者,治疗组别患者的临床治愈率及好转率明显高于对照组别的患者,而且其并发症的发生率显著的低于临床对照组别的患者,相关的临床数据上的差异有统计学上的意义(P0.05);治疗组患者的住院治疗的相关时间、费用显著低于对照组的吻合口瘘患者,治疗组别患者的医疗治疗满意度、好评度显著高于对照组的吻合口瘘患者,相关的临床数据上的差异具有显著的统计学上的治疗意义,(P0.05)。结论:采用内镜下置管内引流治疗胸内胃食管吻合口瘘的临床疗效确切,能明显减少患者吻合口瘘闭合时间,提高治愈率,减少患者带管时间、并发症的发生率及住院治疗时间,降低患者医疗费用,提高患者医疗满意度及生存质量,该方法简单易行,创伤小,患者容易接受,临床实用价值高,有利于吻合口瘘患者的彻底恢复,值得在临床上推广使用。
[Abstract]:Objective: to investigate the clinical effect of endoscopic tube drainage in the treatment of thoracic gastroesophageal anastomotic fistula. Methods: from January 2010 to January 2016, 50 patients with intrathoracic gastroesophageal anastomotic fistula treated in Qingzhou people's Hospital and Yidu Central Hospital were analyzed retrospectively. 50 patients were treated with methylene blue orally. The diagnosis and diagnosis of upper digestive tract lipiodol angiography and gastroscopy were in accordance with esophageal carcinoma and esophagogastric anastomotic fistula after cardiac cancer operation. However, severe pulmonary infection or chylothorax must be excluded in patients with esophageal and cardiac cancer after surgery. 50 patients were randomly divided into two groups: control group (n = 23) and treatment group (n = 27). Control group: 15 males, 8 females, 41-77 years old with an average age of 53.201.36 years, 16 patients with esophageal carcinoma and 7 patients with cardiac carcinoma. The treatment group consisted of 16 males and 11 females, aged 42-76 years, with an average age of 52.831.27 years, esophageal carcinoma in 21 cases and cardiac carcinoma in 6 cases. The choice of patients in the operation mode, general conditions and other aspects are basically the same, the difference is not significant (P0.05). The patients in both groups were treated with general conservative treatment, such as unobstructed drainage, venous nutrition, gastrointestinal decompression and antibiotic anti-infection. The patients in the treatment group were treated with endoscopy and internal drainage on the basis of the above conservative treatment. And daily with physiological saline repeated washing, and finally injected with sensitive antibiotics. At the same time, as the purulent cavity around the fistula gradually shrank, the drainage catheter was gradually withdrawn. Finally, until the exudate is less than 5 ml per day, the color is clear, there is no obvious pus and flocculant, under the direct view of gastroscope, the silica gel catheter is pulled out, and the inner mouth of the anastomotic leakage is sealed by titanium clip or sprayed with OB glue under the direct view of gastroscope. The time of internal drainage, the closure time of fistula, the clinical cure rate of esophagogastric anastomotic fistula and the incidence of complications were observed. The clinical treatment effect and hospitalization time of the two groups were compared. Cost and medical satisfaction. Results: the closing time and the time of anastomotic fistula in the treatment group were significantly shorter than those in the experimental group, and the clinical cure rate and the improvement rate in the treatment group were significantly higher than those in the other patients in the control group. The incidence of complications was significantly lower than that of other patients in the control group, and the difference in the related clinical data was statistically significant (P0.05). The related time of hospitalization in the treatment group was significantly lower than that of the anastomotic fistula patients in the control group, and the satisfaction degree of the treatment group was significantly higher than that in the control group. The difference in clinical data was statistically significant (P0.05). Conclusion: the clinical curative effect of endoscopically placed tube internal drainage in the treatment of thoracic gastroesophageal anastomotic fistula is definite. It can obviously reduce the closure time of anastomotic fistula, improve the cure rate and reduce the time of the anastomotic fistula. The incidence of complications, the duration of hospitalization, the reduction of patients' medical expenses, the improvement of patients' satisfaction with medical treatment and the quality of life were proved to be simple, easy to implement, less traumatic, easy to accept by patients, and of high clinical and practical value. It is beneficial to the complete recovery of anastomotic fistula and is worth popularizing in clinic.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.4
[Abstract]:Objective: to investigate the clinical effect of endoscopic tube drainage in the treatment of thoracic gastroesophageal anastomotic fistula. Methods: from January 2010 to January 2016, 50 patients with intrathoracic gastroesophageal anastomotic fistula treated in Qingzhou people's Hospital and Yidu Central Hospital were analyzed retrospectively. 50 patients were treated with methylene blue orally. The diagnosis and diagnosis of upper digestive tract lipiodol angiography and gastroscopy were in accordance with esophageal carcinoma and esophagogastric anastomotic fistula after cardiac cancer operation. However, severe pulmonary infection or chylothorax must be excluded in patients with esophageal and cardiac cancer after surgery. 50 patients were randomly divided into two groups: control group (n = 23) and treatment group (n = 27). Control group: 15 males, 8 females, 41-77 years old with an average age of 53.201.36 years, 16 patients with esophageal carcinoma and 7 patients with cardiac carcinoma. The treatment group consisted of 16 males and 11 females, aged 42-76 years, with an average age of 52.831.27 years, esophageal carcinoma in 21 cases and cardiac carcinoma in 6 cases. The choice of patients in the operation mode, general conditions and other aspects are basically the same, the difference is not significant (P0.05). The patients in both groups were treated with general conservative treatment, such as unobstructed drainage, venous nutrition, gastrointestinal decompression and antibiotic anti-infection. The patients in the treatment group were treated with endoscopy and internal drainage on the basis of the above conservative treatment. And daily with physiological saline repeated washing, and finally injected with sensitive antibiotics. At the same time, as the purulent cavity around the fistula gradually shrank, the drainage catheter was gradually withdrawn. Finally, until the exudate is less than 5 ml per day, the color is clear, there is no obvious pus and flocculant, under the direct view of gastroscope, the silica gel catheter is pulled out, and the inner mouth of the anastomotic leakage is sealed by titanium clip or sprayed with OB glue under the direct view of gastroscope. The time of internal drainage, the closure time of fistula, the clinical cure rate of esophagogastric anastomotic fistula and the incidence of complications were observed. The clinical treatment effect and hospitalization time of the two groups were compared. Cost and medical satisfaction. Results: the closing time and the time of anastomotic fistula in the treatment group were significantly shorter than those in the experimental group, and the clinical cure rate and the improvement rate in the treatment group were significantly higher than those in the other patients in the control group. The incidence of complications was significantly lower than that of other patients in the control group, and the difference in the related clinical data was statistically significant (P0.05). The related time of hospitalization in the treatment group was significantly lower than that of the anastomotic fistula patients in the control group, and the satisfaction degree of the treatment group was significantly higher than that in the control group. The difference in clinical data was statistically significant (P0.05). Conclusion: the clinical curative effect of endoscopically placed tube internal drainage in the treatment of thoracic gastroesophageal anastomotic fistula is definite. It can obviously reduce the closure time of anastomotic fistula, improve the cure rate and reduce the time of the anastomotic fistula. The incidence of complications, the duration of hospitalization, the reduction of patients' medical expenses, the improvement of patients' satisfaction with medical treatment and the quality of life were proved to be simple, easy to implement, less traumatic, easy to accept by patients, and of high clinical and practical value. It is beneficial to the complete recovery of anastomotic fistula and is worth popularizing in clinic.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.4
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