食管吻合口扩张术后再狭窄的危险因素分析

Risk Factors for Esophageal Anastomosis Restenosis after Esophageal Dilation

目的探讨食管癌术后吻合口狭窄行扩张治疗后再狭窄的影响因素。方法回顾性分析解放军第307医院2002~2013年83例食管癌术后吻合口狭窄患者的临床资料,其中男61例、女22例,年龄58.9（41~81）岁;根据扩张后是否出现再狭窄对多种因素进行统计学检验和多自变量logistic回归分析。结果在行食管扩张的83例术后食管吻合口狭窄患者中,35例（42.2%）在1年随访中出现再狭窄。Logistic回归分析结果显示食管癌术后3个月内出现狭窄（Wald值=23.3,P〈0.001）、狭窄扩张时间间隔大于4周（Wald值=4.8,P=0.029）和扩张后狭窄直径〈12 mm（Wald值=5.8,P=0.016）是吻合口狭窄扩张后再狭窄的独立危险因素。结论对于食管癌术后吻合口狭窄的患者,我们认为扩张时间间隔在4周内,狭窄处扩张直径达12 mm以上,有利于减少再狭窄的发生。

Objective To investigate the risk factor for restenosis of esophageal anastomosis stricture after esophageal cancer operation. Methods We retrospectively analyzed the clinical data of 83 patients including 61 males and 22 females at age of 58.9（41-81） years with esophageal anastomoic stricture after esophageal cancer operation between January 2002 and December 2013. According to whether the patients developed to restenosis or not, the statistical test and logistic regression was conducted to analyze the risk factors for restenosis. Results In the 83 patients with esophageal anastomoic stricture after esophageal cancer surgery, 35 patients（42.2%） experienced restenosis within the followingup of 1 year. The result of logistic regression analysis indicated that restenosis appeared in 3 months（Wald value=23.3, P〈0.001）, the interval between two subsequent sessions of more than 4 weeks at each esophagus dilatation（Wald value=4.8, P=0.029） and the stricture diameter of less than 12 mm after dilation（Wald value=5.8, P=0.016） are the independent risk factors for restenosis in esophageal anastomotic stricture. Conclusion For the patients with esophageal anastomoic stricture after esophageal cancer operation, we believe that it＇s conducive to reduce esophageal restenosis if the interval between dilations is within 4 weeks and the diameter of stricture after dilation can reach above 12 mm.