食管癌McKeown术后颈部吻合口瘘危险因素分析

Analysis of the risk factors for postoperative cervical anastomotic leakage after McKeown＇ s esophagectomy

目的 探讨食管癌患者行左颈、右胸、腹部三切口食管切除术（McKeown术）后发生颈部吻合口瘘的危险因素。方法 回顾性分析2012年1月至2015年12月于中国医学科学院肿瘤医院行McKeown术的635例患者的临床资料，分析患者的病史、手术过程、肿瘤特点和血管钙化等临床病理特征，分析影响患者颈部吻合口瘘的危险因素。结果 全组患者食管切除术后吻合口瘘的发生率为17.5%（111/635）。单因素分析显示，术前美国麻醉医师协会（ASA）分级、胸部手术史、上消化道溃疡、慢性阻塞性肺疾病、高血压病、外周血管病、肾功能不全、一秒用力呼气容积与用力肺活量比值、一氧化碳弥散量占预计值的百分比、手术时间、降主动脉钙化、腹腔动脉钙化和腹腔动脉左侧分支钙化与颈部吻合口瘘均有关，差异均有统计学意义（均P〈0.05）。Logistic分析结果显示，ASA分级、外周血管病、肾功能不全、降主动脉钙化和腹腔动脉钙化均为食管癌McKeown术后发生颈部吻合口瘘的独立危险因素（均P〈0.05）。结论 ASA分级、外周血管病和肾功能不全与McKeown术后发生颈部吻合口瘘密切相关，降主动脉和腹腔动脉钙化也是导致颈部吻合口瘘的独立危险因素。

Objective To analyze risk factors of anastomotic leakage after McKeown＇sesophagectomy.Methods The clinical data of 635 esophageal cancer patients, who underwent McKeown＇s esophagectomy at Cancer Hospital of Chinese Academy of Medical Sciences from January 2012 to December 2015, were retrospectively analyzed. The risk factors of cervical anastomotic leakage were identified through analysis of medical history, surgical procedure, tumor characteristics and vascular calcification.Results Among all the 635 patients, anastomotic leakage occurred in 111 （17.5%）patients. Univariate analysis showed that the American Society of Anesthesiologists （ASA） risk class, prior thoracic surgery, upper digestive tract ulcer, COPD, hypertension, peripheral vascular disease, renal insufficiency, FEV1% predicted, DLCO% predicted, duration of surgery and calcification of descending aorta, celiac trunk and left postceliac arteries were associated with a statistically significant increase in risk of cervical anastomotic leakage （P〈0.05 for all）. Logistic regression analysis showed that ASA risk class, peripheral vascular disease, renal insufficiency and calcification of descending aorta and celiac trunk were independent risk factors of cervical anastomotic leakage after McKeown＇s esophagectomy （P〈0.05 for all）.Conclusions ASA risk class, peripheral vascular disease, renal insufficiency, calcification of descending aorta and celiac trunk are independent risk factors of cervical esophageal anastomotic leakage after McKeown＇s esophagectomy.