持续封闭负压引流处理咽瘘的效果观察

Effect of continuous sealing negative pressure drainage in the treatment of pharyngeal fistula

摘要:

目的 评估持续封闭负压引流处理咽瘘的效果。方法 回顾性分析2019年6月—2021年11月于山东省立医院耳鼻咽喉头颈外科因喉癌、下咽癌、下咽癌合并食管癌、颈段食管癌行肿瘤切除并咽部直接吻合修补或使用组织瓣、管状胃、游离空肠等行咽部修复的患者117例，其中咽瘘者18例，咽瘘患者均用持续封闭负压引流方式处理咽瘘,分析其治疗过程及其术后疗效。结果 18例咽瘘患者中，发现咽瘘时间为术后第4~26天，中位时间9 d；咽瘘持续时间为10~52 d，中位时间20 d。所有咽瘘患者咽瘘口均用持续封闭负压引流方式保守治疗愈合，均无需再行手术修补。结论 持续封闭负压引流可减轻咽瘘患者痛苦、减少医师换药操作时间、缩短咽瘘持续时间，减少咽瘘发展至手术修补的几率。

关键词:咽喉癌;食管癌;咽瘘;持续封闭负压引流

Abstract:

Objective To evaluate the effect of continuous sealing negative pressure drainage in the treatment of pharyngeal fistula.Methods A retrospective analysis was made on 117 patients who underwent tumor resection and repair of pharyngeal direct anastomosis or pharyngeal repair with tissue flap, tubular stomach or free jejunum in our department from June 2019 to Nov 2021. Of them, 18 cases of pharyngeal fistula were included and treated with continuous sealing negative pressure drainage. The treatment process and postoperative efficacy were analyzed by descriptive statistics.Results Among the 18 patients with pharyngeal fistula, the time of pharyngeal fistula was found to be 4 to 26 days after operation (median time=9 days), and the duration of pharyngeal fistula was 10 to 52 days (median time=20 days). Pharyngeal fistula healed in all the patients with conservative management of continuous sealing negative pressure drainage without surgical repair.Conclusion Continuous sealing negative pressure drainage can alleviate patient’s suffering, reduce the dressing change operation time of doctors, shorten the duration of pharyngeal fistula, and reduce the probability of pharyngeal fistula developing to surgical repair.

Key words:Hypopharyngeal and laryngeal carcinoma;Esophageal cancer;Pharyngeal fistula;Continuous sealing negative pressure drainage