持续低氧血症对食管重建术后吻合口狭窄的影响

Sustained-hypoxemia：a significant risk factor for anastomotic cicatricial stenosis after esophagectomy

目的分析食管重建术后吻合口瘢痕狭窄的相关因素，尤其相关的全身性因素。方法回顾性分析中山大学附属肿瘤医院收治的1111例食管癌切除、消化道重建术患者的病例资料，对可能导致吻合口瘢痕狭窄的全身及局部因素进行logistic单因素、多因素回归分析，并对筛选出的因素进行相关分析。结果单因素回归分析显示：术后持续低氧血症（P=0．003）、胸部并发症（P=0．000）、吻合口瘘（P=0．000）、糖尿病史（P=0．019）、慢性阻塞性肺病病史（P=0．046）和心血管并发症（P=0．015）6项因素有统计学意义；而多因素回归分析则显示仅持续低氧血症（P=0．044）、胸部并发症（P=0．009）、吻合口瘘（P=0．001）和糖尿病史（P=0．036）4项因素有统计学意义：相关分析显示：持续低氧血症与胸部并发症及吻合口瘘三者之间呈正相关。结论持续低氧血症是食管重建术后吻合口瘢痕狭窄的重要全身性因素。

Objective To analyze retrospectively the roles of different factors, especially the factors in the anastomotic cicatricial, stenosis after esophagectomy. Methods The clinical data of 1111 patients, undergone esophagectomy with immediate reconstruction for cancer in the Sun Yat-sen Cancer Center from December 1997 to December 2003, were analyzed retrospectively. Up to 19 factors were evaluated by univariate and multivariate logistic regression analysis with SPSS 11.5 for windows. Spearman rank correlation was used to evaluate the factors that were statistically significant in Logistic regression analysis. Results The overall incidence of anastomotic cicatricial stenosis was 6.84%. By using univariate Logistic regression, sustained-hypoxemia （P=0.003）, chest complications （P=0.000）, anastomotic leakage （P=0.000）, a history of diabetes （P=0.019）, a history of chronic obstructive pulmonary disease （P=0.046） and cardiovascular complications （P=0.015） came out to be significantly related to anastomotic stenosis. Multivariate Logistic regression showed that sustained- hypoxemia （P=-0.044）, chest complications （P=0.009）, anastomotic leakage （P=0.001） and a history of diabetes （P=0.036） were statistically significant. Spearman rank correlation estimation revealed that sustained-hypoxemia was positively correlated with chest complications （r=0.105） and anastomotic leakage, （r=0.106）, and chest complications were positively correlated with anastomotic leakage （r= 0.228）. Conclusion Sustained-hypoxemia is one of the significant factors for anastomotic cicatricial stenosis after esophagectomy.