食管癌术中脾意外切除对术后并发症及预后的影响

Influence of Unexpected Simultaneous Splenectomy on Postoperative Complications and Prognosis of Patients Undergoing Radical Esophagectomy for Esophageal Carcinoma

背景与目的:在食管癌根治术中常因脾损伤或解剖结构变异而导致脾意外切除。本研究旨在探讨食管癌根治术中脾意外切除的原因及其对术后并发症及预后的影响。方法:分析843例根治性切除术(R0切除)的胸段食管鳞癌患者的临床病理资料,843例患者中有39例(4.6%)行脾意外切除术,采用t检验及χ2检验比较脾切除组与脾保留组之间各临床病理参数及预后。结果:脾切除组与脾保留组在性别、年龄、肿瘤部位、肿瘤长度、pTNM分期等方面的差异无统计学意义(P>0.05);脾切除组术中失血量高于脾保留组,其差异有统计学意义[(380±113)mlvs.(305±85)ml,P<0.001];术后肺部并发症脾切除组高于脾保留组,但其差异无统计学意义(17.9%vs.8.5%,P>0.05);中位生存时间脾切除组略低于脾保留组,差异无统计学意义(18.4个月vs.21个月,P>0.05);并发症、术后住院时间、院内死亡率以及术后长期生存时间的差异均无统计学意义(P值均>0.05)。结论:食管癌根治术中脾意外切除对患者的长期生存并无显著影响,但增加了术中失血量以及肺部并发症。

BACKGROUND ＆ OBJECTIVE： Unexpected splenectomy is sometimes performed simultaneously with radical esophagectomy for esophageal carcinoma because of spleen injury or anatomical abnormity. This study was to investigate the influence of unexpected simultaneous splenectomy on postoperative complications and prognosis of patients undergoing radical esophagectomy for esophageal carcinoma. METHODS ： Clinical data of 843 esophageal carcinoma patients, underwent esophagectomy （R0 resection） at Cancer Center of Sun Yat-sen University from Aug. 1999 to Jul. 2002, were analyzed. Of these patients, 39 （4.6% ） underwent splenectomy. The clinicopathologic parameters and prognosis of the patients in splenectomy group and non-splenectomy group were compared. RESULTS ： The amount of intraoperative blood loss was significantly higher in splenectomy group than in non-splenectomy group [ （380±113） ml vs. （305±85） ml, P〈0.001]. However, there were no significant differences in clinicopathologic characteristics, intraoperative or postoperative complications between the 2 groups （P 〉0.05）. The occurrence rate of pulmonary complications was higher in splenectomy group than in non-splenectomy group （17.9% vs. 8.5%, P〉0.05）. The median survival time was shorter in splenectomy group than in non-splenectomy group （18.4 months vs. 21 months, P 〉0.05）. CONCLUSION： Unexpected simultaneous splenectomy had no effect on the long-term survival of patients who underwent radical esophagectomy for esophageal carcinoma, but it may result in more intraoperative blood loss and pulmonary complications.