| 【BACKGROUND AND OBJECTIVE】: Esophageal cancer is one of themost common malignant tumor of digestive tract. there are about300000peopledying of the disease every year in the world. China is a high incidence area ofesophageal cancer, especially in rural areas. In the present,Surgical treatment is stillone of the important means of treatment of esophageal carcinoma, postoperativeroutine needs a closed thoracic drainage tube, the purpose is to eliminate thehemorrhage, fluid,gas and pungent substances coming from pleural internaloperation trauma, to eliminate dead space,to promote inflammation subsided,restoring and maintaining negative intrathoracic pressure, promoting lung,srecruitment as soon as possible,and preventing the occurrence of variouscomplications of lung and heart. Anastomotic fistula and cardiopulmonarycomplications are the common complications after resection of esophagealcarcinoma, the anastomotic fistula causeds the most serious consequences. Foreignliterature reports that the incidence of anastomotic leakage after operation ofesophageal carcinoma is about2%-15%, the death rate is up to50%. The left chestoperation of this topic in our hospital for treatment of60cases of esophageal cancerpatients in routine placement of thoracic closed drainage tube placement ofmediastinal based on drainage tube, with another60patients without placingmediastinal drainage tube as the left chest operation treatment of esophagealcarcinoma in the same period patients conducted in drainage, thoracic tube removaltime, cardiopulmonary complications, such as anastomotic fistula analysis, toexplore the left thoracic esophagectomy in mediastinal drainage tube placed in effectand the significance of prevention and treatment of cardiopulmonary complications,such as anastomotic fistula aspect; at the same time through statistical analysis oftwo groups of right thoracic puncture rate, to evaluate the left thoracic esophagealcarcinoma resection of mediastinal drainage tube placement is of special significanceto the operation right mediastinal pleura rupture patients in the prevention ofpostoperative complications.【METHODS】: There are120cases of esophageal cancer patients, including 84cases of male,36cases of female, their age is42-74years old; there are108casesof squamous cell carcinoma,5cases of adenosquamous carcinoma,7casesadenocarcinoma. According to the time sequence,60of120patients come fromesophageal cancer patients(2013.01-2013.12in our hospital) needing operationtreatment (preoperative gastroscopy and pathology are necessary), defining as thestudy group, patients in the base of routine placement of thoracic closed drainagetube place the mediastinal drainage tube; the other60cases patients in our hospitalfrom the period also need operation treatment of patients with esophageal carcinoma,provisioning for the control group, patients were placed closed thoracic drainagetube, not placed mediastinum drainage tube. In120patients,78underwent cervicalanastomosis (Study Group41cases, Control Group37cases),42cases ofintrathoracic anastomosis below aortic arch (Study Group19cases, Control Group23cases). Through the observation in the mediastinum drainage tube and closedthoracic drainage tube drainage, the study group and the control group, the rightchest puncture drainage total number, postoperative chest drainage tube removaltime, postoperative cardiopulmonary complications and the incidence of anastomoticleakage, statistical analysis, to explore application of value of the mediastinumdrainage tube in the resection of esophageal carcinoma by the left chest.【RESULTS】:1. The average volume of two drainage tube was (753.6±136.4)ml in the study group, the average volume of the control group was (594.7±116.8)ml, the total volume of the study group was significantly higher than the controlgroup, there were significant differences between two groups (P<0.05);2. Theaverage volume of mediastinum drainage tube was (536.8±108.3)ml in the studygroup, accounted for about70%of the total volume of pleural drainage;3.Theaverage time of extubation was (3.2±0.5) days in the study group, The average timeof extubation was (3.3±0.6) days in the control group, there were no significantdifferences between two groups (P>0.05);4.4cases occurred postoperativeanastomotic fistulain in the study group,5cases occurred postoperative anastomoticfistulain in the control group,there were no significant differences between twogroups (P>0.05);5.8cases occurred postoperative pulmonary complications in the study group, the control group had18cases, the control group had a significantlyhigher incidence, there were significant differences between two groups (P<0.05);6.12cases occurred postoperative arrhythmia occurred in the study group, the controlgroup had23cases, the control group had a significantly higher incidence, therewere significant differences between two groups (P<0.05);7.24patients occurredthe rupture of right mediastinal pleura in the study group, the control group had25cases, there were no significant differences between two groups (P>0.05);8.5casesneeded right thoracic puncture in the study group, the control group had16cases,there were significant differences between two groups (P<0.05);9. In the patients ofright mediastinal pleura rupture,4cases needed right thoracic puncture in the studygroup, the control group had14cases, there were significant differences betweentwo groups (P<0.05).【CONCLUSION】:1. Placed on the left chest after resection of esophagealcancer patients can achieve better drainage of mediastinum drainage tube, itsignificantly reduced the incidence of cardiopulmonary complications, it may haveimportant clinical significances in the prevention of cardiopulmonary complications,but it will stimulate the body to produce drainage needs further study;2. Theplacement of mediastinal drainage tube for the left thoracic resection of esophagealcarcinoma can get a good drainage effect for right mediastinal pleura rupture, itsignificantly reduced the incidence of the right related complications, it may havemore clinical significance in the patients of right mediastinal pleura rupture patients;3. The placement of mediastinal drainage tube had no significant preventive effectfor the occurrence of anastomotic fistula after the resection of esophageal cancer,which may have a important role in the early diagnosis and treatment of theanastomotic leakage, but further research is needed to prove;4. The placement ofmediastinal drainage tube had no obvious effect on the removal of closed thoracicdrainage tube;5. About70%of the volume of thoracic drainage come from thewound after the operation of esophageal cancer. |
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