[Application of bundles of intervention in the treatment of esophageal carcinoma anastomotic leak].
OBJECTIVE
To investigate the application of bundles of intervention in the treatment of esophageal carcinoma anastomotic leak.


METHODS
From January 2014 to May 2015, 44 cases of esophageal carcinoma anastomotic fistula were treated by bundles of intervention (through the collection of a series of evidence-based treatment and care measures for the treatment of diseases) in Department of Thoracic Surgery, Huai'an First Hospital, Nanjing Medical University (bundles of intervention group), and 68 patients with esophageal carcinoma postoperative anastomotic leak from December 2013 to January 2012 receiving traditional therapy were selected as the control group. The clinical and nutritional indexes of both groups were compared.


RESULTS
There were no significant differences in general data and proportion of anastomotic leak between the two groups. Eleven patients died during hospital stay, including 3 cases in bundles of intervention group(6.8%) and 8 cases in control group (11.8%) without significant difference(P = 0.390). In bundles of intervention group, 1 case died of type III( intrathoracic anastomotic leak, 2 died of type IIII( intrathoracic anastomotic leak. In control group, 2 cases died of type III( cervical anastomotic leak, 2 died of type III( intrathoracic anastomotic leak and 4 of type IIII( intrathoracic anastomotic leak. The mortality of bundles of intervention group was lower than that of control group. The duration of moderate fever [(4.1±2.4) days vs. (8.3±4.4) days, t=6.171, P=0.001], the time of antibiotic use [(8.2±3.8) days vs.(12.8±5.2) days, t=5.134, P = 0.001], the healing time [(21.5±12.7) days vs.(32.2±15.8) days, t=3.610, P=0.001] were shorter, and the average hospitalization expenses[(63±12) thousand yuan vs. (74±19) thansand yuan, t=3.564, P=0.001] was lower in bundles of intervention group than those in control group. Forty-eight hours after occurrence of anastomotic leak, the levels of hemoglobin, albumin and prealbumin were similar in both groups. However, at the time of fistula healing, the levels of hemoglobin [(110.6±10.5) g/L vs.(103.8±11.1) g/L, t=3.090, P=0.002], albumin [(39.2±5.2) g/L vs.(36.3±5.9) g/L, t=2.543, P=0.013] and prealbumin [(129.3±61.9) g/L vs.(94.1±66.4) g/L, t=2.688, P=0.008] were significantly higher in bundles of intervention group.


CONCLUSIONS
In the treatment of postoperative esophageal carcinoma anastomotic leak, application of bundles of intervention concept can significantly improve the nutritional status and improve the clinical outcomes.
Wenze
W
Tian
Zhongwu
Z
Hu
Department of Thoracic Surgery, Huai'an First Hospital, Nanjing Medical University, Jiangsu Huai'an 223300, China. 799501150@qq.com.
Jian
J
Ji
Dafu
D
Xu
Zhenbing
Z
You
Wei
W
Guo
Keping
K
Xu
D057868:Anastomotic Leak / Q000401:mortality / Q000628:therapy*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002277:Carcinoma / Q000150:complications* / Q000601:surgery; D004937:Esophageal Fistula / Q000150:complications / Q000401:mortality / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D006454:Hemoglobins / Q000378:metabolism; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D064872:Patient Care Bundles / Q000401:mortality / Q000706:statistics & numerical data*; D011228:Prealbumin / Q000378:metabolism; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D006454:Hemoglobins; D011228:Prealbumin; D012709:Serum Albumin