负压引流结合持续微氧渗透治疗三切口食管癌术后颈部吻合口瘘的效果观察
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摘要
目的探讨负压引流结合持续微氧渗透创面治疗三切口食管癌术后颈部吻合口瘘的效果。方法选择2015年7月—2018年9月行三切口食管癌术后发生颈部吻合口瘘的32例患者,随机分为对照组与研究组,各16例。对照组患者瘘口给予常规负压引流治疗,研究组在对照组基础上,针对患者瘘口增加持续微氧渗透治疗。对比2组干预后第1、3、5、7天吻合口瘘肉芽组织覆盖率,评价治疗效果,记录愈合时间、患者住院天数及住院费用。结果干预后第3、5、7天,研究组颈部吻合口瘘肉芽组织覆盖率升高较对照组明显(P<0.01)。研究组治愈率87.53%(14/16),高于对照组的56.25%(9/16),但差异无统计学意义(P>0.05)。研究组瘘口愈合时间短于对照组(P<0.01),患者住院时间和住院费用均低于对照组(P<0.05)。结论负压引流结合持续微氧渗透治疗颈部吻合口瘘,可促进其肉芽组织生长,缩短瘘口的愈合时间。
Objective To investigate the effect of negative-pressure drainage combined with continuous diffusion of oxygen(CDO) in the treatment of cervical anastomotic leakage following three-incision esophagectomy for esophageal cancer. Methods Totally 32 patients with three-incision esophagectomy for esophageal cancer were recruited and were randomly allocated to the experimental group and the control group(n=16 in each group). The control group received negative pressure drainage for the treatment of cervical anastomotic leakage, and the experimental group received CDO combined with negative pressure drainage. The granulation tissue coverage rate of the anastomotic leakage site at 1, 3, 5 and 7 days after intervention was compared between two groups. The overall healing rate and duration of healing, the length of hospital stays, and costs were compared between two groups. Results The granulation tissue coverage rate of the anastomotic leakage site in the experimental group was higher than that in the control group at 3, 5 and 7 days after intervention(P<0.01). The overall healing rate in the experimental group was higher than that in the control group(87.53% vs. 56.25%, P>0.05). The healing duration, the hospitalization stays and the costs were lower in the experimental group than those in the control group(P<0.05). Conclusion Negative-pressure drainage combined with CDO treatment can promote the growth of granulation tissue and shorten the total healing time of patients with three-incision esophagectomy for esophageal cancer.
Objective To investigate the effect of negative-pressure drainage combined with continuous diffusion of oxygen(CDO) in the treatment of cervical anastomotic leakage following three-incision esophagectomy for esophageal cancer. Methods Totally 32 patients with three-incision esophagectomy for esophageal cancer were recruited and were randomly allocated to the experimental group and the control group(n=16 in each group). The control group received negative pressure drainage for the treatment of cervical anastomotic leakage, and the experimental group received CDO combined with negative pressure drainage. The granulation tissue coverage rate of the anastomotic leakage site at 1, 3, 5 and 7 days after intervention was compared between two groups. The overall healing rate and duration of healing, the length of hospital stays, and costs were compared between two groups. Results The granulation tissue coverage rate of the anastomotic leakage site in the experimental group was higher than that in the control group at 3, 5 and 7 days after intervention(P<0.01). The overall healing rate in the experimental group was higher than that in the control group(87.53% vs. 56.25%, P>0.05). The healing duration, the hospitalization stays and the costs were lower in the experimental group than those in the control group(P<0.05). Conclusion Negative-pressure drainage combined with CDO treatment can promote the growth of granulation tissue and shorten the total healing time of patients with three-incision esophagectomy for esophageal cancer.
引文
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[9] 张玉斌,刘雅彬,李文献,等.食管胃胸内吻合口全脱开的外科治疗[J].中华胸心血管外科杂志,1999,15(2):104-105.
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[11] 赵宏波,郝安林,王卫杰.颈部持续负压引流装置治疗食管癌术后颈部吻合口瘘的价值[J].河南外科学杂志,2016,22(4):60-61.
[12] 徐娟,蒋琪霞,刘颖,等.给氧负压封闭伤口治疗在骨科慢性伤口中的应用效果研究[J].中华护理杂志,2016,51(6):650-654.
[13] 杨帆,胡耑,白祥军,等.负压创面治疗对兔创面氧分压变化和血管化的影响[J].中华外科杂志,2012,50(7):650-654.
[14] 王维,裴永菊,孟祥惠.VSD技术联合氧气治疗Ⅳ期压疮的效果观察[J].中国卫生标准管理,2016,7(13):76-77.
[15] 刘武夷,何爱咏,宁卫权.封闭式负压引流术(VSD)治疗Ⅳ期压疮疗效观察[J].中国现代手术学杂志,2012,16(5):369-372.
[2] RUTEGARD M,LAGERGREN P,ROUVELAS I,et al.Intrathoracic anastomotic leakage and mortality after esophageal cancer resection:a population-based study[J].Ann Surg Oncol.2012,19(1):99-103.
[3] 李杰,项咏梅,王树军,等.食管癌切除术后颈部吻合口瘘的临床分析[J].中国肿瘤外科杂志,2009,1(4):245-246.
[4] 蒋琪霞,李晓华,彭青,等.负压伤口治疗技术用于53例慢性伤口的效果评价[J].中华护理杂志,2012,47(4):293-296.
[5] 冯志凯,刘华.伤口愈合机制的研究进展[J].中华外科杂志,2012,50(4):368-372.
[6] LESSING M C,JAMES R B,INGRAM S C.Comparison of the Effects of Different Negative Pressure Wound Therapy Modes—Continuous,Noncontinuous,and With Instillation—on Porcine Excisional Wounds[J].Eplasty,2013,13(10):443-455.
[7] SEN C K.Wound healing essentials:let there be oxygen[J].Wound Repair Regen,2010,17(1):1-18.
[8] 赵格非,张坤鹏,高树庚,等.食管癌McKeown术后颈部吻合口瘘危险因素分析[J].中华肿瘤杂志,2017,39(4):287-292.
[9] 张玉斌,刘雅彬,李文献,等.食管胃胸内吻合口全脱开的外科治疗[J].中华胸心血管外科杂志,1999,15(2):104-105.
[10] 郭红霞,许寿霞,刘焱.经右胸食管癌切除术后62例颈部体位与颈部吻合口瘘的关系[J].新乡医学院学报,2002,19(6):520-520.
[11] 赵宏波,郝安林,王卫杰.颈部持续负压引流装置治疗食管癌术后颈部吻合口瘘的价值[J].河南外科学杂志,2016,22(4):60-61.
[12] 徐娟,蒋琪霞,刘颖,等.给氧负压封闭伤口治疗在骨科慢性伤口中的应用效果研究[J].中华护理杂志,2016,51(6):650-654.
[13] 杨帆,胡耑,白祥军,等.负压创面治疗对兔创面氧分压变化和血管化的影响[J].中华外科杂志,2012,50(7):650-654.
[14] 王维,裴永菊,孟祥惠.VSD技术联合氧气治疗Ⅳ期压疮的效果观察[J].中国卫生标准管理,2016,7(13):76-77.
[15] 刘武夷,何爱咏,宁卫权.封闭式负压引流术(VSD)治疗Ⅳ期压疮疗效观察[J].中国现代手术学杂志,2012,16(5):369-372.