Fluoroscopically Guided Three-Tube Insertion for the Treatment of Postoperative Gastroesophageal Anastomotic Leakage

OBJECTIVE: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). MATERIALS AND METHODS: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. RESULTS: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 +/- 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 +/- 0.40 g/dL) to post-enteral feeding (3.7 +/- 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). CONCLUSION: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.

Application of early enteral nutrition with "Freka Trelumina" and "Supportan" after esophageal and cardiac carcinoma operation / 肠外与肠内营养

Objectives: To explore the feasibility and safety of EEN with Freka Trelumina and Supportan after esophageal and cardiac carcinoma operation.Methods: 30 patients with esophageal and cardiac carcinoma were retained Freka Trelumina in to jejunum during the operation.All patients were given EEN with Supportan on the 3rd day after the operation.The complication and resumption of digestive tract functions were observed and recorded carefully.Renal and Liver functions were examined on the 8~(th) day after operation.Results: No mortality and serious complication occurred in all patients during the period of study.There was no evidence of damage of EEN to the renal and liver function. Conclusion: EEN with Freka Trelumina and Supportan after esophageal and cardiac carcinoma is feasible and safe.

Effect of psychological intervention on the anxious reaction of perioperative patients with esophageal and cardiac carcinoma / 中国医学伦理学

We investigated the psychological condition of 70 inpatients who had esophageal and cardiac carcinoma before radical operation with Hamilton Anxiety Scales.For the patients with anxiety,we carried out psychological intervention before operation which includes general care,follow-up,collective psychotherapy,keep disease condition individually and so on.The results showed the treatment had great benefit to most of the patients.