內(nèi)引流治療胸內(nèi)胃食管吻合口瘺的臨床療效觀察
發(fā)布時間：2018-11-22 08:07
【摘要】：目的:探討內(nèi)鏡下置管內(nèi)引流治療胸內(nèi)胃食管吻合口瘺的臨床療效。方法:回顧性分析自2010年1月至2016年1月期間在青州市人民醫(yī)院及益都中心醫(yī)院治療的50例胸內(nèi)胃食管吻合口瘺患者,50例患者均通過口服亞甲藍(lán)、上消化道碘油造影和胃鏡檢查來進行診斷及確診,均符合食管癌、賁門癌術(shù)后胸內(nèi)食管-胃吻合口瘺,但必須排除以下情況:食管癌及賁門癌患者手術(shù)后出現(xiàn)嚴(yán)重的肺部感染或乳糜胸者。將所選50例患者隨機分為對照組和治療組,對照組23例患者,治療組27例患者。對照組:男性:15例,女性8例;年齡41-77歲,平均年齡(53.20?1.36)歲;食管癌16例,賁門癌7例。治療組:男性16例,女性11例;年齡42-76歲,平均年齡(52.83?1.27)歲;食管癌21例,賁門癌6例。所選擇的患者在手術(shù)方式、一般情況等方面基本相同,差異不顯著(P0.05)。兩組患者均給予通暢引流、靜脈營養(yǎng)、胃腸減壓及抗生素抗感染等一般保守治療,治療組患者在以上保守治療基礎(chǔ)上加用內(nèi)鏡下置管內(nèi)引流治療,并且每日用生理鹽水反復(fù)進行沖洗,最后注入敏感抗生素。同時,隨著瘺口周圍膿腔逐漸縮小,逐步將引流導(dǎo)管外退。最后,直到每日抽出滲出液少于5ml,顏色清亮,無明顯膿液及絮狀物,在胃鏡直視下,拔出硅膠導(dǎo)管,吻合口瘺口的內(nèi)口在胃鏡直視下予以鈦夾夾閉或噴灑OB膠封堵。觀察兩組患者的內(nèi)引流等置管時間、瘺口閉合時間、食管-胃吻合口瘺的臨床治愈率及患者的并發(fā)癥發(fā)生率,比較兩組患者的臨床治療效果、住院治療時間、費用及醫(yī)療滿意度等。結(jié)果:治療組患者的吻合口瘺口閉合時間及帶管時間明顯短于實驗組的患者,治療組別患者的臨床治愈率及好轉(zhuǎn)率明顯高于對照組別的患者,而且其并發(fā)癥的發(fā)生率顯著的低于臨床對照組別的患者,相關(guān)的臨床數(shù)據(jù)上的差異有統(tǒng)計學(xué)上的意義(P0.05);治療組患者的住院治療的相關(guān)時間、費用顯著低于對照組的吻合口瘺患者,治療組別患者的醫(yī)療治療滿意度、好評度顯著高于對照組的吻合口瘺患者,相關(guān)的臨床數(shù)據(jù)上的差異具有顯著的統(tǒng)計學(xué)上的治療意義,(P0.05)。結(jié)論:采用內(nèi)鏡下置管內(nèi)引流治療胸內(nèi)胃食管吻合口瘺的臨床療效確切,能明顯減少患者吻合口瘺閉合時間,提高治愈率,減少患者帶管時間、并發(fā)癥的發(fā)生率及住院治療時間,降低患者醫(yī)療費用,提高患者醫(yī)療滿意度及生存質(zhì)量,該方法簡單易行,創(chuàng)傷小,患者容易接受,臨床實用價值高,有利于吻合口瘺患者的徹底恢復(fù),值得在臨床上推廣使用。
[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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R655.4
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