食管癌患者三切口食管切除术后严重并发症及其危险因素分析

Incidence and risk factors of serious complications in patients with esophageal cancer after three-incision esophagectomy

目的观察食管癌患者三切口食管切除术后严重并发症的发生情况,分析影响患者发生并发症的危险因素。方法选取2019-12-10-2021-12-27河南科技大学第一附属医院收治的98例行三切口食管切除术的食管癌患者为研究对象,应用Clavien-Dindo分级系统对术后并发症进行分类,将发生Ⅱ~Ⅴ级并发症者纳入并发症组(n=42),未发生并发症以及轻微I级并发症者纳入无并发症组(n=56)。比较2组患者临床相关资料,多因素logistic回归分析影响发生并发症的危险因素。结果98例患者中,42例发生Ⅱ~Ⅴ级并发症,发生率为42.86%。Ⅱ级并发症23例,发生率为23.47%,其中肺部感染11例,吻合口瘘7例,胃肠功能紊乱3例,乳糜胸2例。Ⅲ级并发症15例,发生率为15.31%,其中ⅢA 9例,包括液气胸5例、肺部感染+引流不畅3例、吻合口瘘1例;ⅢB 6例,包括腹腔淋巴瘘4例、吻合口瘘2例。Ⅳ~Ⅴ级并发症4例,发生率为4.08%,其中Ⅳ级3例,均为肺部感染+呼吸衰竭;Ⅴ级1例,为因消化道出血死亡。单因素分析结果显示,并发症组患者合并糖尿病、有腹部手术史占比分别为59.52%、33.33%,高于无并发症组的35.71%、14.29%,χ^(2)值分别为5.479、5.002,P值分别为0.019、0.025;手术时间为(238.69±52.67)min,长于无并发症组的(212.34±50.18)min,t=2.518,P=0.013;清除淋巴结数为(17.93±6.32)枚,多于无并发症组的(14.21±7.21)枚,t=2.663,P=0.009。logistic回归分析结果显示,手术时间(OR=1.980,95%CI为1.137~3.448,P=0.016)和清除淋巴结数(OR=1.761,95%CI为1.044~2.972,P=0.035)为影响术后严重并发症发生的危险因素。结论食管癌患者三切口食管切除术后严重并发症以肺部感染多见,手术时间长、清除淋巴结数量多为影响术后严重并发症发生的独立危险因素。

Objective To observe the occurrence of serious complications in patients with esophageal cancer after three-incision esophagectomy,and analyze the risk factors of complications.Methods A retrospective analysis was performed on the 98 patients with esophageal cancer undergoing three-incision esophagectomy in the First Affiliated Hospital of Henan University of Science and Technology between December 10,2019 to December 27,2021.The postoperative complications were classified by Clavien-Dindo grading system.The patients with complications at gradesⅡ-Ⅴwere included in complication group(n=42),while those without complications and with mild complications at gradeⅠwere included in non-complication group(n=56).The clinical data between the two groups were compared.The risk factors of complications were analyzed by multivariate logistic regression analysis.Results Among the 98 patients,there were 42 cases(42.86%)with gradesⅡ-Ⅴcomplications and 23 cases(23.47%)with gradeⅡcomplications,including 11 cases with pulmonary infection,7 cases with anastomotic leakage,3 cases with gastrointestinal dysfunction and 2 cases with chylothorax.There were 15 case(15.31%)with gradeⅢcomplications:9 cases were diagnosed as gradeⅢA,including 5 cases with hydropneumothorax,3 cases with pulmonary infection and inadequate drainage,and 1 case with anastomotic leakage;6 cases were graded asⅢB,including 4 cases with abdominal lymphatic fistula and 2 cases with anastomotic leakage.There were 4 cases(4.08%)with gradesⅣ-Ⅴcomplications,including 3 cases with gradeⅣcomplications(pulmonary infection combined with respiratory failure),and 1 case with gradeⅤcomplications,who died of gastrointestinal bleeding.Univariate analysis results show that the proportion of patients with diabetes mellitus and history of abdominal surgery in complication group was higher than that in non-complication group(59.52%vs 35.71%),(33.33%vs 14.29%)(χ^(2)=5.479,5.002,P=0.019,0.025).The operation time of the complication group was longer than that of the non-complication group(238.69±52.67)vs(212.34±50.18)min(t=2.518,P=0.013),and the number of dissected lymph nodes was more than that of the non-complication group(17.93±6.32)vs(14.21±7.21)(t=2.663,P=0.009).logistic analysis showed that operation time(OR=1.980,95%CI:1.137-3.448,P=0.016)and number of dissected lymph nodes(OR=1.761,95%CI:1.044-2.972,P=0.035)were risk factors of serious postoperative complications.Conclusion Pulmonary infection is the most serious complication after three-incision esophagectomy in patients with esophageal cancer.Long operation time and excessive dissected lymph nodes are independent risk factors of serious postoperative complications.