Clinical Research On The Influencing Factors And Prevention Methods Of Mediastinal Drainage Tube Inserted Into Anastomotic Stoma After Esophageal Carcinoma Surgery

Objective To explore the main influencing factors of mediastinal drainage tube inserted into anastomotic stoma after esophageal carcinoma surgery.Proposing a kind of anastomotic technique to effectively prevent mediastinal drainage tube from inserting into anastomotic stoma.Methods(1)We retrospectively analyzed the clinical data of 503 patients from January 2014 to July 2019.Among them,376 cases were male,127 cases were female,26cases had mediastinal drainage tube inserted into anastomotic stoma.The possible influencing factors were selected for univariate analysis and Logistic multivariate regression analysis to determine the influencing factors of mediastinal drainage tube inserted into anastomotic stoma after esophageal carcinoma surgery.(2)Then 503 cases of esophageal cancer operation patients were selected and divided into two groups according to the anastomosis method.203 cases of esophagogastric anastomosis with mucosa prolongation and omental pedicle flap wrapping were taken as the observation group,and 175 cases of esophagogastric anastomosis with traditional method were taken as the control group.Comparing the incidence of mediastinal drainage tube insertion,anastomotic stenosis,anastomotic bleeding and postoperative hospitalization time between the two groups.Results(1)Univariate analysis found that low plasma albumin levels(P=0.002),postoperative vomiting(P=0.004),postoperative pneumonia(P=0.040),anastomotic leakage(P=0.039),catheter location(P=0.028),esophagogastric anastomosis with mucosa prolongation(P=0.041)and covering anastomotic without omentum(P=0.001)were significantly related to the insertion of mediastinal drainage tube into the anastomotic stoma.Logistic multivariate regression analysis revealed that postoperative vomiting(P=0.011,OR=2.877,95%CI=1.223?8.172),low plasma albumin levels(P=0.008,OR=2.904,95%CI=1.534?5.971)and covering anastomotic without omentum(P=0.001,OR=3.518,95%CI=1.523?5.148)were the independent risk factors of the mediastinal drainage tube embedded in the anastomotic stoma.(2)In the observation group,203cases were hospitalized(14.7±4.9)days on average,5 cases had mediastinal tube inserted into the anastomotic stoma,2 case had anastomotic stenosis,3 case had anastomotic bleeding.In the control group,175 cases were treated by routine postoperative treatment,the average postoperative hospital stay was(17.1 ±7.6)days,12 cases had mediastinal tube inserted into anastomotic stoma,2 case had anastomotic stenosis,2 cases had anastomotic bleeding.The incidence of mediastinal intubation in the observation group was significantly lower than that in the control group(P<0.05).The difference of hospitalization time between the two groups was statistically significant(P<0.05),and there was no significant difference in anastomotic stenosis and bleeding(P>0.05).Conclusion Low plasma albumin levels,postoperative vomiting and covering anastomotic without omentum were the independent risk factors of the mediastinal drainage tube embedded in the anastomotic stoma.Esophagogastric anastomosis with mucosa prolongation and omental pedicle flap wrapping can effectively prevent mediastinal drainage tube inserted into anastomotic stoma after operation.It can significantly shorten the postoperative hospital stay,and will not increase the incidence of complications such as anastomotic stenosis and anastomotic bleeding.In summary,the improved method is convenient,safe and worthy to be promoted.