| Objective：To compare the effects of different gastrointestinal decompressions (asepsisglove gastrointestinal decompression, medical accordion gastrointestinaldecompression, open vacuum aspiration and closed vacuum aspiration) in vitro gastricesophagus model. To discuss the relevance between esophageal anastomosis leaksafter esophagectomy and gastrointestinal decompressions in clinic. To summarize theexperience of treating the complex esophageal anastomosis leaks and spontaneousesophageal rupture by Comprehensive drainage method.Methods:1. We made the gastric esophagus model in vitro using the stomach esophagusof pig. By simulating gastrointestinal decompression (asepsis glove gastrointestinaldecompression, medical accordion gastrointestinal decompression, open vacuumaspiration and closed vacuum aspiration) in vitro gastric esophagus model, themaximum negative pressure value in and after the process of drainage, the height ofgastric juice column after drainage and the total volume of drainage were observed.Data was analysed and summarized to evaluate the effect of the4methods ofgastrointestinal decompression.2. We retrospectively analysed173complete clinical data of patients withesophagus cancer who received operation from the thoracic department of academy ofmilitary medical sciences affiliated hospital between1998and2013. The data weredivided into three groups(asepsis glove gastrointestinal decompression, medicalaccordion gastrointestinal decompression, open vacuum aspiration and closed vacuumaspiration) according to the methods which the gastrointestinal decompression usedafter operation. The patients’ age, sex, course of disease, the location of lesion, theimaging data, pathological type,the length of the lesion, treatment, complication and the therapy after operation were collected. The information was inputted and analysedby SPSS19.0. The volume of drainage was recorded asx±s. Measurement data usedone-way ANOVA analysis of variance, and multiple comparison used Bonferroni test.Enumeration data used chi-square test. Significant level is α=0.05. We try to discussthe effect of different gastrointestinal decompression methods and determine therelevance between the incidence rate of esophageal leaks and gastrointestinaldecompression methods and which method is most effective.3. Esophageal anastomosis leaks is the main reason causing death afteresophagectomy. We retrospected4patients with complex esophageal anastomosisleaks and3patients with spontaneous rupture of esophagus who failed to be cured inthe early stage between1998and2013from the thoracic department of academy ofmilitary medical sciences affiliated hospital. By summarizing the experience about thetreatment of complex esophageal anastomosis leaks and spontaneous rupture ofesophagus, We believe that comprehensive drainage coordinated with operation is asafe, active and effective way to treat complex spontaneous esophageal rupture in latestage. Comprehensive drainage is a method of drainage based on the traditionaldrainage (multi-catheters in chest and mediastinum, tubes in stomach and intestine fordecompression)and combines with T-tube near esophageal and double tubes with sideholes for gastrointestinal decompression. In this way, chest, mediastinum and theorifice around the rupture of esophagus will get adequate drainage. As the chestand the area near repairment are kept clean and dry, the orifice of the rupture will healsoon.Results:1. The effect of conventional gastrointestinal decompression by drainage: thevolume of asepsis glove drainage is0ml and the maximum vacuum aspiration is0cmH2O,meaning that asepsis glove drainage had no effect in vitro gastric esophagusmodel. Accordion drainage can reach100cmH2O of maximum vacuum aspirationinitially, but decline to20-25cmH2O soon. The volume of accordion drainage is about55-80ml. Open vacuum aspiration can reach140cmH2O of maximum vacuumaspiration and sustain at30cmH2O. The volume of drainage is about120ml to130ml.Closed vacuum aspiration generate40cmH2O and the vacuum aspiration is stable.Almost all the500ml gastric juice can be drained. All in all, vacuum aspiration cansustain longer drainage and larger volume compared with accordion drainage. While both of them were incapable of reaching sufficient drainage and the vacuumaspiration were unstable. Closed vacuum aspiration had advantage at this aspect.However, the vacuum aspiration and accordion drainage can reach more than100cmH2O vacuum aspiration. Whether this negative pressure leads to hemorrhageand necrosis and whether the large amount of lost gastric juice leads to disorders ofWater, electrolyte and acid-base balance still need further study. Therefore, closedvacuum aspiration, open vacuum aspiration, glove drainage, accordion drainage havestatistical difference in drainage volume and maximum vacuum aspiration.2. Among the173patients, there are61patients using glove drainage. Theaverage Of the4days postoperation drainage are43.62ml,46.29ml,50.90ml,52.63ml,31accordion drainage with average drainage of53.25ml,61.38ml,75.16ml,80.38mland81vacuum aspiration with average drainage of67.04ml、89.48ml、103.12ml、105.19ml.10patients were diagnosed with esophageal anastomosis leaks(3in glovegroup,3in accordion group,4in vacuum aspiration). The result of statistics analysisindicates that glove drainage, accordion drainage and vacuum aspiration havestatistical difference in drainage volume during the4days of postoperation (P<0.05);have no statistical difference in the incidence rate of esophageal anastomosisleaks(P>0.05). The drainage volume during the4days of postoperation has nocorrelation with the incidence rate of esophageal anastomosis leaks(P>0.05).3.4patients with complex esophageal anastomosis leaks and3patients withspontaneous rupture of esophagus received simple hiatal repairment, mediastinaldrainage, chest drainage, gastrointestinal decompression, vacuum aspiration,esophageal rupture repairmen and T-tube drainage. The drainage tubes in chest andmediastinum were pulled out14-29days after operation. T-tube was pulled out after30-36days and stomach tube was pulled out after39-40days. None of the patientsencountered chest pain, bucking, pyrexia, dysphagia when they took food. Afterhandling the sinus tract as routine in the later period, the patients got recovery anddischarged from hospital successfully. The reexamination at2-3months and1yearafter discharge was favorable.Conclusion:1.As the experiments in vitro verify, Closed vacuum aspiration can reachsufficient drainage and sustain a stable vacuum and its drainage effect is best.2.There are differences among the volume of different gastrointestinal decompressions in clinic. The vacuum aspiration has the best effect of gastrointestinaldecompression, accordion drainage next and glove drainage last.3. The means of gastrointestinal decompression and the volume of drainage haveno correlation with the incidence rate of esophageal anastomosis leaks. In other words,the volume of drainage has nothing to do with the esophageal anastomosis leaks.4. Comprehesive drainage （include double tubes with multiple side holesstomach tubes drainage, T-tube drainage, drainage in mediastinum and chest） is avery important drainage method of treating the patients with complex esophagealanastomosis leaks or spontaneous rupture of esophagus and its clinical effect issatisfied. |
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