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投稿时间：2022-06-29 网络发布日期：2023-02-20
投稿时间：2022-06-29 网络发布日期：2023-02-20
中文摘要: 目的 探讨对食管癌术后吻合口瘘采用内镜下双向置管法治疗的临床疗效。方法 选择2017年8月至2020年10月中山市人民医院收治的食管癌术后并发吻合口瘘患者211例进行回顾性研究，采取常规静脉营养支持及胃肠减压治疗的105例作为对照组，将在内镜下置入瘘腔引流管至瘘口、置入三腔营养管至空肠治疗的106例作为观察组。比较两组患者吻合口瘘愈合时间、恢复进食时间、住院时间和瘘口愈合率，及前白蛋白、白蛋白、血红蛋白、铁转蛋白等营养状态指标及生活质量（SF-36量表）。根据累积和分析（CUSUM）法将观察组患者分为学习提高阶段（n=60）和熟练掌握阶段（n=46），分析其吻合口瘘愈合时间及住院时间随手术例数增多的变化趋势。结果 与对照组比较，观察组患者瘘口愈合时间、恢复进食时间及住院时间显著降低，瘘口愈合率、SF-36量表评分及前白蛋白、白蛋白、血红蛋白及转铁蛋白等水平显著增高（P＜0.01）。熟练掌握阶段患者瘘口愈合时间、恢复进食时间、住院时间、疼痛评分及体力恢复情况评分均显著低于学习提高阶段（P＜0.01）。结论内镜下双向置管法治疗食管癌术后吻合口瘘，安全有效，可显著提高瘘口愈合率，完成60例后可熟练掌握该术式。
Abstract:ObjectiveTo investigate the clinical effect of endoscopic two-way catheterization in the treatment of anastomotic fistula after esophageal cancer surgery. MethodsFrom August 2017 to October 2020, 211 patients with postoperative anastomotic fistula of esophageal cancer treated in Zhongshan People's Hospital were selected for retrospective study. The 105 patients treated with routine intravenous nutritional support and gastrointestinal decompression were served as control group. The 106 patients placed with fistula drainage tube to the fistula mouth and three lumen nutritional tube to the jejunum under endoscopy was served as observation group. The fistula healing time, recovery eating time, hospital stays, clinical cure rate of the anastomotic fistula, nutritional status indexes(prealbumin, albumin, hemoglobin and transferrin) and the quality of life(SF-36 scale) were compared between two groups. According to CUSUM method, all cases were divided into learning improvement stage(n=60) and mastery stage(n=46), the change trend of anastomotic fistula healing time and hospital stay in the observation group with the increase of the number of surgical cases was analyzed. ResultsCompared with the control group, the fistula healing time, recovery eating time and hospital stays in the observation group were significantly reduced, and the clinical cure rate of the anastomotic fistula, SF-36 scale score and nutritional status indexes such as prealbumin, albumin, hemoglobin and transferrin were significantly increased(P＜0.01). The fistula healing time, recovery eating time and hospital stays, pain score and physical recovery score of patients in the mastery stage were significantly lower than those in the learning improvement stage(P＜0.01). ConclusionsEndoscopic two-way catheterization is safe and effective in the treatment of postoperative anastomotic fistula of esophageal cancer,60 cases can master the operation and improve the clinical curative effect.
keywords: Two-way catheterization Esophageal cancer Anastomotic fistula Albumin Hemoglobin Learning curve
文章编号： 中图分类号： 文献标志码：A
基金项目:2021年度中山市第一批社会公益与基础研究项目（2021B1014）
| 作者 | 单位 |
| 杨玉宇1 | 1. 中山市人民医院消化内科，广东 中山 528403； |
| 黄伟钊2 | 2. 中山市人民医院心胸外科，广东 中山 528403； |
| 吴颖猛2 | 2. 中山市人民医院心胸外科，广东 中山 528403； |
| 丁信1 | 1. 中山市人民医院消化内科，广东 中山 528403 |
| Author Name | Affiliation |
| YANG Yu-yu*, HUANG Wei-zhao, WU Ying-meng, DING Xin | *Department of Gastroenterology, Zhongshan Peoples Hospital, Zhongshan, Guangdong 528403, China |
引用文本：
杨玉宇,黄伟钊,吴颖猛,等.内镜下双向置管法治疗食管癌术后吻合口瘘的疗效及学习曲线[J].中国临床研究,2023,36(2):191-195.
杨玉宇,黄伟钊,吴颖猛,等.内镜下双向置管法治疗食管癌术后吻合口瘘的疗效及学习曲线[J].中国临床研究,2023,36(2):191-195.