Comparison Of Two Methods Of Placement Of Nasal Tube In Ivor-Lewis For Esophageal Cancer

Objective:This study aims to compare two different methods to perform nasointestinal tubes(NITs)during Ivor-Lewis esophagectomy.Methods:A total of 119 esophageal carcinoma patients who had undergone Ivor-Lewis esophagectomy in the Department of Thoracic Surgery,First Affiliated Hospital of Nanjing Medical University between June 2015 and December 2016 were enrolled in this study.NITs were performed in all patients during operation.We recorded the time-used,successful rate,influence on circulatory system during NIT insertion,postoperative complications,and nutritional status in the two groups who underwent antegrade or retrograde methods.Result:All operations were successfully completed,while 57 cases with antegrade methods and 62 cases with retrograde methods.The time-used in patients accepted the antegrade method was 26.3±11.2 minutes,and in those with retrograde method was 9.5±2.6 minutes,the time of performing retrograde method was significantly less than that of antegrade method(P<0.001).NITs in 47 cases were successfully passed through pylorus by using the antegrade method,while all NITs in 62 cases were successfully performed by using the retrograde method,and the success rate of retrograde method was higher than that of antegrade(100%vs 82.5%,P<0.001).6 patients experienced transient arrhythmias or decreased blood pressure due to compression of the heart during performing the antegrade method.However,retrograde catheterization did not cause any compression of the heart.The retrograde procedure with less influence on the circulatory system compare to antegrade(0 vs 10.5%,P=0.01).The levels of serum albumin and retinol binding protein were not significantly different between the two groups before surgery,in the 1st day and the 7th day after surgery,respectively(all P>0.05).There were 7 cases suffered pulmonary infection in the antegrade group,while 8 cases n in the retrograde group.There was no significant difference in pulmonary infection between the two groups(P=0.919).Routine blood test showed that there was no significant difference in WBC count between the two groups(P=0.189)in the 7th day after surgery.There were no significant difference in the incidence of complications between the two groups(P=0.783).Conclusion:Performing NITs by the retrograde method during Ivor-Lewis esophagectomy is a safe and effective methods,which has a wider clinical application value.