689例食管癌切除术后并发症情况分析

Analysis of Postoperative Complications in 689 Patients Treated with Radical Esophagectomy

目的:食管癌患者营养状况差,年龄较大,肺功能欠佳,同时食管癌手术涉及胸、腹及颈部器官,手术创伤大、复杂、耗时长,术后并发症亦较多。减少食管癌术后并发症的发生,降低死亡率是食管外科中应予十分重视的问题。本研究的目的是探讨食管癌切除术的主要并发症及危险因素,对手术治疗效果进行评估。方法:分析研究本院肿瘤外科1996年3月至2007年3月期间实施的689例食管癌切除术术后主要并发症的发生情况。结果:食管癌切除术后并发症发病率为19.9%,其中肺部并发症9.3%,吻合口瘘4.8%,气胸2.8%,乳糜胸0.9%,脓胸0.6%。院内死亡率为3.6%,因肺部并发症死亡者占56.0%,因吻合口瘘死亡者占20.0%。颈部吻合的瘘发病率高于胸内吻合(P<0.01):吻合器吻合的瘘发病率、肺部并发症发病率及院内死亡率均低于手工吻合(P<0.05),瘘死亡率及肺部并发症死亡率两者无显著差异;肿瘤位置是术后并发症的独立危险因素。结论:食管癌切除术后并发症仍以肺部并发症和吻合口瘘多见,且为主要死亡原因。使用吻合器能显著降低术后并发症的发生率及死亡率。

Objective： To analyze the effects, main complications and the risk factors of radical esophogectomy in patients with esophageal cancer. Methods： Between 1996 and 2007, 727 patients with esophageal cancer were admitted to our hospital and 689 of them were treated with radical esophagectomy. We analyzed the clinical data and postoperative complications of these patients. Results： The morbidity rate from complications was 19.9%. The main complications included pulmonary complications （9.3%）, anastomotic leak （4.8%）, pneumothorax （2.8%）, chylothorax （0.9%）, and empyema （0.6%）. The in-hospital mortality rate was 3.6%. The main causes of death were pulmonary complications （56.0%） and anastomotic leak （20.0%）. The leak rate in cervical anastomoses was higher than that in intrathoracic anastomoses （P〈0.01）. The leak rate, pulmonary complication rate and in-hospital mortality rate in patients treated with mechanical anastomoses were lower than those in patients treated with manual anastomoses （P〈0.05）. No significant difference was found in the mortality rate due to leakage and pulmonary complications between the group treated with mechanical anastomosis and the group treated with manual anastomosis. Multivariate analysis revealed tumor location as an independent risk factor associated with the development of complications. Conclusion： The major difficulties in patients after radical esophagectomy were pulmonary complications and anastomotic leaks. They are also the main causes of in-hospital death. We recommend using a stapler because it is very effective in reducing the complication morbidity rates and in-hospital mortality rate.