Application Of Double-Chamber Irrigation Drainage Tube In Intrathoracic Anastomotic Leakage After Esophagectomy

Background and objective:Esophageal cancer is one of the digestive malignant tumors with the highest incidence in the world.The main treatment method is esophageal resection combined with esophageal reconstruction.Among them,anastomotic leakage is one of the most dangerous postoperative complications.It can lead to an increased risk of death during hospitalization,increasing patient suffering,length of hospital stay,and cost.In addition,it can lead to scarring of the esophagus,resulting in a lower quality of life in patients and a poor prognosis.Postoperative anastomotic leakage in esophageal cancer divides into neck anastomotic leakage and intrathoracic anastomotic leakage.The postoperative management of neck anastomotic leakage is based on open incision,dressing and debridement.Due to its location,the intrathoracic anastomotic leakage is difficult for surgical treatment,which increases the difficulty of drainage,with the concealed early symptoms.The abscess is formed around the leak,leading to local infection spread and systemic infection.At present,people are still controversial in the choice of early surgical repair and conservative treatment.We studied the treatment of anastomotic leakage after esophageal cancer surgery and analyzed the application of double-chamber irrigation drainage tube in the intrathoracic anastomotic leakage.In addition,we evaluated the effects of continuous irrigation and intermittent negative pressure drainage in eliminating the abscess and promoting the healing of the fistula,providing a new treatment method,which enriches clinical experience and provides theoretical supportin the early treatment of intrathoracic anastomotic leakage in esophageal cancer.Methods:The study collected the clinical data of patients suffering anastomotic leakage after esophagectomy in Peking University Shenzhen Hospital from November 2014 to July 2018,to analyze their clinical features,treatment methods and prognosis during hospitalization.According to the exclusion criteria,we got 9 patients with the complicated anastomotic leakage of gas and liquid abscesses larger than 3 cm in diameter suitable for conservative treatment.These patients underwent double-chamber irrigation drainage tube placement,in which daytime drainage combined with flat-pressure drainage and nighttime vacuum drainage.We analyzed the application value of double-chamber irrigation drainage tube in intrathoracic anastomotic leakage and evaluated its advantages and disadvantages,furthermore,summarized the experience of early diagnosis and treatment of anastomotic leakage after esophageal cancer operation.Results:Tube placement process: All patients were successfully placed in the double-chamber irrigation drainage tube at the bedside.One patient developed paroxysmal cough during the placement of the tube.We immediately suspended the operation and assessed the patient's vital signs,and the tube was reinserted after the cough was relieved.The remaining patients did not complain of discomfort and pain during the placement of the tube.Therapy process: Three patients developed cough during lavage drainage and all appeared during drainage.After excluding the esophagus-tracheal fistula,reducing the rate of drainage droplets while symptomatic treatment can alleviate cough in patients.Two patients developed palpitation and stuffy while bedside electrocardiogrammonitoring showed rapid atrial fibrillation.After diagnosis by bedside electrocardiogram,we successfully converted the patient's heart rhythm into sinus rhythm.The remaining patients had no obvious discomfort during the irrigation or drainage process.There were no serious complications such as tubular gastric necrosis,septic shock,ARDS or intracranial infection.No patients underwent secondary surgery or endotracheal intubation.Therapy outcomes: All 9 patients were cured and no patients died.The average healing time of the leakage was 23-57(36.1±10.8)days.The time to return to normal levels of body temperature was 1-16(5.7±4.9)days and the total number of white blood cells returned to normal levels was 6-27(11.7±7.3)days.Conclusion:Double-chamber irrigation drainage tube is effective to eliminating abscess.it reduce complications,and mortality,shorten hospitalization time and cost,and provides a new treatment mode for intrathoracic anastomotic leakage after esophagectomy.