纵隔镜和腹腔镜辅助食管癌切除术中经裂孔胸腔引流治疗食管癌的回顾性研究

背景
尽管保留了纵隔胸膜，但纵隔镜和腹腔镜辅助食管癌切除术偶尔会导致术后胸腔积液。 据报道，经裂孔胸腔引流可用于胸段食管切除术； 然而，其在纵隔镜和腹腔镜辅助食管切除术中的应用仍未阐明。 本研究旨在评估经裂孔胸腔引流在纵隔镜和腹腔镜辅助食管切除术中的有效性和安全性。

方法
这项回顾性研究纳入了 2018 年至 2021 年接受纵隔镜和腹腔镜辅助食管切除术治疗食管癌的患者。经裂孔胸腔引流涉及将 19-Fr Blake® 引流管从腹部通过裂孔插入左胸腔。作者通过每日引流量、术后胸腔积液积聚、术后胸腔穿刺术频率和其他并发症评估其有效性和安全性。 将引流组 24 例与非引流组 13 例进行比较，非引流组在纵隔镜和腹腔镜辅助食管切除术中未放置经裂孔胸腔引流管。

结果
经裂孔胸腔引流的中位日输出量为第 1 天 230 mL，第 2 天 385 mL，第 3 天 313 mL。术后胸腔积液患者人数从 10/13（76.9%）明显减少 非引流组为引流组的 4/24 (16.7%) (p = 0.001)。 引流组胸腔穿刺频率显著低于非引流组（p =⟩0.002）。 其他术后并发症的发生率无显著差异。

结论
纵隔镜和腹腔镜辅助食管切除术后经裂孔胸腔引流可有效、安全地引流胸腔积液。

纵隔镜和腹腔镜辅助食管癌切除术中经裂孔胸腔引流治疗食管癌的回顾性研究

图 1
术中照片显示 Blake 引流管通过裂孔从肝下腔插入左胸腔。 箭头，食管裂孔

纵隔镜和腹腔镜辅助食管癌切除术中经裂孔胸腔引流治疗食管癌的回顾性研究

图 2
Blake 引流管在术中从肝下腔通过裂孔插入左胸腔的示意图。 箭头，食管裂孔

纵隔镜和腹腔镜辅助食管癌切除术中经裂孔胸腔引流治疗食管癌的回顾性研究

图 3
术后胸片。 箭头，经裂孔左胸腔引流管

纵隔镜和腹腔镜辅助食管癌切除术中经裂孔胸腔引流治疗食管癌的回顾性研究

图 4
每日胸腔积液引流量。 a 四分位距

参考资料：
1. Sakurai M, Morinaga K, Shimoyama K, Mishima S, Oda J. Effects of pleural drainage on oxygenation in critically ill patients. Acute Med Surg. 2020;7:e489. doi: 10.1002/ams2.489.   
2. Fujiwara H, Shiozaki A, Konishi H, Otsuji E. Mediastinoscope and laparoscope-assisted esophagectomy. J Vis Surg. 2016;2:125. doi: 10.21037/jovs.2016.07.08.   
3. Fujiwara H, Shiozaki A, Konishi H, Kosuga T, Komatsu S, Ichikawa D, et al. Perioperative outcomes of single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer. Dis Esophagus. 2017;30:1–8. doi: 10.1093/dote/dox047.   
4. Hamada J, Konishi H, Shiozaki A, Fujiwara H, Shoda K, Kosuga T, et al. Management of pleural effusion after mediastinoscopic radical esophagectomy. Anticancer Res. 2018;38:6919–6925. doi: 10.21873/anticanres.13069.   
5. Gogalniceanu P, Crewdson K, Khan AZ, Botha AJ. Transhiatal chest drainage after oesophagectomy. Ann R Coll Surg Engl. 2007;89:535–536. doi: 10.1308/rcsann.2007.89.5.535.   
6. Asti E, Sironi A, Bonitta G, Bernardi D, Bonavina L. Transhiatal chest drainage after hybrid Ivor lewis esophagectomy: Proof of concept study. J Laparoendosc Adv Surg Tech A. 2018;28:429–433. doi: 10.1089/lap.2017.0580.   
7. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7. Oxford: Wiley-Blackwell; 2010.
8. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213. doi: 10.1097/01.sla.0000133083.54934.ae.   
9. Zheng Y, Li Y, Liu X, Zhang R, Wang Z, Sun H. Feasibility of a single mediastinal drain through the abdominal wall after esophagectomy. Medicine (Baltimore) 2018;97:4–8. doi: 10.1097/MD.0000000000013234.   
10. Brunelli A, Beretta E, Cassivi SD, Cerfolio RJ, Detterbeck F, Kiefer T, et al. Consensus definitions to promote an evidence-based approach to management of the pleural space: a collaborative proposal by ESTS, aATs, STS, and GTSC. Eur J Cardiothorac Surg. 2011;40:291–297. doi: 10.1016/j.ejcts.2011.05.020.   
11. Miserocchi G. Physiology and pathophysiology of pleural fluid turnover. Eur Respir J. 1997;10:219–225. doi: 10.1183/09031936.97.10010219.   
12. Law S, Boey JP, Kwok KF, Wong KH, Chu KM, Wong J. Pleural drainage after transthoracic esophagectomy: experience with a vacuum system. Dis Esophagus. 2004;17:81–86. doi: 10.1111/j.1442-2050.2004.00380.x.   
13. Wang D, Xu L, Yang F, Wang Z, Sun H, Chen X, et al. The improved mediastinal drainage strategy for the enhanced recovery system after esophagectomy. Ann Thorac Surg. 2021;112:473–480. doi: 10.1016/j.athoracsur.2020.05.188.   
14. Niwa Y, Koike M, Oya H, Iwata N, Kobayashi D, Kanda M, et al. Method of bilateral pleural drainage by single blake drain after esophagectomy. World J Surg. 2015;39:727–731. doi: 10.1007/s00268-014-2860-0.