食管吻合口瘘内引流法提高胸腔内吻合口瘘恢复的评价分析

Evaluation and Analysis of the Improvement of Intrathoracic Anastomotic Fistula Recovery by Internal Drainage of Esophageal Anastomotic Fistula

摘要: 目的：食管吻合口瘘患者行内引流促进胸腔内食管吻合口瘘恢复的疗效评估。方法：回顾性分析2023年1月至2024年12月在安徽医科大学第二附属医院胸外科行食管癌根治术术后出现胸腔内吻合口瘘患者56例，其中行食管吻合口瘘内引流术患者29例，未行特殊治疗措施的吻合口瘘病人27例，对这些患者的术后瘘口愈合时间、发热持续时间、引流管置管时间、出院时间、体重下降情况、病人疼痛时间等进行评估，结果：食管吻合口瘘内引流组相比对照组术后瘘口愈合时间更短[(36.45 ± 9.23) d vs (65.34 ± 17.58) d, P = 0.002]，术后引流量更少[(1074 ± 198.43) mL vs (2012 ± 286.67) mL, P = 0.009]，引流管置管时间短[(23.73 ± 9.98) d vs (54.13 ± 12.67) d, P = 0.016]，发热累计时间短[(7.64 ± 3.83) d vs (15.84 ± 6.24) d, P = 0.021]，出院时间短[(38.69 ± 10.19) d vs (67.35 ± 18.07) d, P = 0.004]，术后BMI下降程度低[(19.94 ± 1.23) kg/m² vs (18.36 ± 1.87) kg/m², P = 0.035]，病人疼痛持续时间更短[(16.21 ± 8.45) d vs (22.23 ± 10.18) d, P = 0.033]，压疮发生率更低(3.45% vs 25.93%, P = 0.023)。结论：食管吻合口瘘内引流法可以促进食管吻合口瘘的愈合，改善病人术后恢复情况，降低护理负担，值得临床推广。

Abstract: Objective: To evaluate the efficacy of internal drainage in promoting the recovery of intrathoracic esophageal anastomotic fistula in patients with esophageal anastomotic fistula. Method: A retrospective analysis was conducted on 56 patients with intrathoracic anastomotic fistula after radical resection of esophageal cancer in the Department of Thoracic Surgery of the Second Affiliated Hospital of Anhui Medical University from January 2023 to December 2024. Among them, 29 patients underwent internal drainage of esophageal anastomotic fistula, and 27 patients with anastomotic fistula did not receive special treatment measures. The postoperative fistula healing time, fever duration, drainage tube placement time, discharge time, weight loss, and patient pain duration of these patients were evaluated. Results: The postoperative fistula healing time of the esophageal anastomotic fistula internal drainage group was shorter than that of the control group [(36.45 ± 9.23) d vs (65.34 ± 17.58) d, P = 0.002], the postoperative drainage volume was less [(1074 ± 198.43) mL vs (2012 ± 286.67) mL, P = 0.009], and the drainage tube placement time was shorter [(23.73 ± 9.98) d vs (54.13 ± 12.67) d, P = 0.016]. The cumulative duration of fever was short [(7.64 ± 3.83) d vs (15.84 ± 6.24) d, P = 0.021], and the discharge time was short [(38.69 ± 10.19) d vs (67.35 ± 18.07) d, P = 0.004]. The degree of postoperative BMI decrease was low [(19.94 ± 1.23) kg/m² vs (18.36 ± 1.87) kg/m², P = 0.035], and the duration of pain in patients was shorter [(16.21 ± 8.45) d vs (22.23 ± 10.18) d, P = 0.033]. The incidence of pressure ulcers was lower (3.45% vs 25.93%, P = 0.023). Conclusion: The internal drainage method of esophageal anastomotic fistula can promote the healing of esophageal anastomotic fistula, improve the postoperative recovery of patients, reduce the burden of nursing, and is worthy of clinical promotion.