A longitudinal study of endoscopic naso-leakage negative pressure drainage for anastomotic leak after esophagectomy
A longitudinal study of endoscopic naso-leakage negative pressure drainage for anastomotic leak after esophagectomy
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DOI：
10.1007/s44272-023-00001-9
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发表时间：
2023-12
期刊：
影响因子：
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通讯作者：
Xin-yang Liu;Meng-Jiang He;Yan-Bo Liu;Hao Yin;Li-Jie Tan;Pinglang Zhou;Miao Lin
中科院分区：
文献类型：
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作者：
Xin-yang Liu;Meng-Jiang He;Yan-Bo Liu;Hao Yin;Li-Jie Tan;Pinglang Zhou;Miao Lin
背景和目的术后吻合口漏是食道切除术后的一种危险并发症。本研究旨在通过纵向分析评价鼻内窥镜下鼻漏负压引流治疗吻合口漏的疗效，以期更好地了解患者病程中与引流相关的个体内变化，最大限度地减少个体间差异。我们假设最高体温(Tmax)、最大心率(HRmax)、白细胞计数(WBC)和C反应蛋白(CRP)在引流时有一个缺口的两段线性样条增长曲线。结果共纳入30例患者，其中男性占83.3%，中位年龄77岁。术后中位引流时间16.5天(6~66天)。Tmax、HRmax、WBC、CRP和PCT的观察值分别为1366、1372、394、296和290。在调整了年龄、性别和体重指数后，Tmax、HRmax、WBC和CRP显示出相似的规律。鼻漏负压引流前4项指标随时间无明显变化，鼻漏负压引流后4项指标随时间显著降低。结论鼻漏负压引流后Tmax、HRmax、WBC、CRP随时间变化明显。鼻漏负压引流可使上述炎症指标逐渐降低，有望成为治疗食管术后吻合口漏的有效方法。
Background and aimsPostoperative anastomotic leak is a threatening complication after esophagectomy. This study aims to evaluate the efficacy of endoscopic naso-leakage negative pressure drainage for anastomotic leak by longitudinal analyses, so as to focus on the intra-individual changes associated with the drainage in the disease course and to minimize the between-subject variations.MethodsWe conducted a retrospective longitudinal study. We hypothesize that maximum temperature (Tmax), maximum heart rate (HRmax), White blood cell count (WBC), and C reactive protein (CRP) had a two-piece linear spline growth curve with a notch at the time of drainage. Linear mixed-effects regressions were used to test the hypothesis of whether endoscopic naso-leakage negative pressure drainage changed the pattern of development of these clinical parameters with time.ResultsThirty patients were included, among which 83.3% were male, with a median age of 77 years. The median postoperative time to drainage was 16.5 days (range 6-66). Observations for Tmax, HRmax, WBC, CRP and PCT were 1366, 1372, 394, 296 and 290, respectively. After adjusting for age, sex, and body mass index, Tmax, HRmax, WBC and CRP showed similar pattern. There was no significant change over time before naso-leakage negative pressure drainage, while the four parameters all decreased significantly over time after naso-leakage negative pressure drainage.ConclusionsThe slope over time of Tmax, HRmax, WBC and CRP changed significantly after naso-leakage negative pressure drainage. Naso-leakage negative pressure drainage brought gradual decrease of these inflammatory parameters and could serve as a promising management for postoperative anastomotic leak after esophagectomy.