Objective:To investigate the application of mediastinal vacuum drainage tube in radical operation of esophageal carcinoma and cardiac carcinoma. Methods:In 220 cases with esophageal carcinoma and cardiac carcinoma ,102 cases were placed with vacuum drainage tube ( improvement group) below the anastomotic stoma after reconstruction of digestive tract through left-sided thoracotomy,and 118 cases were not placed with vacuum drainage tube (control group). The effects of anastomotic fistula of the two groups were compared,included the anastomotic leakage,major complications and prognosis. Results:Two groups had be successfully operated on. Anastomotic leakage occurred in 5 cases of improvement group,3 case had high fever, shortness of breath,palpitations. 2 cases had chest infection and 1 case had wound infection. Among the patients with anastomotic leakage, 1 cases were performed with esophageal stent implantation and 1 case died. In control group, 7 patients with anastomotic leakage had high fever, shortness of breath, palpitations, 6 cases had chest infection ( 6/7 ) and 3 case had wound infection ( 3/7 ) ,4 cases were conducted with esophageal stent implantation (4/7);2 cases had secondary surgical clearance of drainage(2/7)and 2 case died. All patients with anastomotic leakage had average maximum temperature 38. 63 ± 0. 32 ℃ and high white blood cell count (19. 02 ± 3. 30) × 109/L. There was no difference between the two groups in incidence of anastomotic leakage ( P>0. 05). There were statistically significant differences in the chest infection, wound infection and mortality between the two groups (P<0. 05). There were statistically differences in average maximum temperature, white blood cell count and hospital stay between the two groups. Conclusion:Mediastinal vacuum drainage tube can’ t reduce incidence of anastomotic fistula,but can reduce chest infection, wound infection, second surgical dissection, death rate, andlength of hospital stay.%目的：：探讨食管根治术中纵隔负压引流的应用价值。方法：将经左胸行食管癌或贲门癌根治性切除患者220例分为改良组102例和对照组118例,改良组在消化道重建后,吻合口下方留置纵隔引流管,外接负压引流球；对照组未留置纵隔引流管。比较2组患者吻合口瘘的发生情况及出现吻合口瘘后的临床表现、主要并发症以及预后情况。结果：2组均顺利完成手术。改良组发生吻合口瘘5例,术后出现高热、气促、心悸等症状3例,其余患者生命体征平稳；发生吻合口瘘患者合并胸腔感染2例,切口感染1例,1例行食管支架植入,死亡1例。对照组发生吻合口瘘7例,术后均出现高热、气促、心悸等不适；发生吻合口瘘患者合并胸腔感染6例,切口感染3例,4例行食管支架植入,2例行二次手术廓清引流,死亡2例。2组吻合口瘘的发生率比较无显著性差异(P>0．05),但胸腔感染、切口感染、死亡率比较有显著性差异(P<0．05),平均最高体温、平均白细胞计数、术后平均住院时间比较有显著性差异(P<0．05)。结论：纵隔负压引流管不能减少食管癌、贲门癌术后吻合口瘘的发生,但可以明显减轻吻合口瘘所致的全身炎症反应,减少胸腔感染、切口感染、二次手术廓清及死亡,缩短住院时间。
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