食管癌术后食管主动脉瘘相关危险因素的病例对照研究

Case-control study on related risk factors of aortic-esophageal fistula after esophageal carcinoma operation

目的探讨食管癌术后发生食管主动脉瘘的相关危险因素。方法以2000年1月至2015年12月在该院胸外科治疗的18例食管癌术后食管主动脉瘘患者为观察组,并按照病例对照研究设计,以1∶3配比,选择同一时期具备近似基础疾病或危险因素的54例食管癌手术患者为对照组。以观察组发病前具有的危险因素,如年龄、性别、肿瘤TNM分期、肿瘤部位作为配比变量。对手术操作时间,术前肥胖情况,术中出血量,术前低密度脂蛋白(LDL)水平,手术吻合方式,术后有无肺部并发症,术后有无心律失常,术前有无高血压,术前有无糖尿病,术中淋巴结清扫数目等非配比变量进行病例对照研究。结果单因素Logistic回归分析初筛出5个可疑危险因素,包括术前肥胖、术前低密度脂蛋白、术后肺部并发症、手术吻合方式及淋巴结清扫数目,其余因素差异无统计学意义(P>0.05)。多因素非条件Logistic逐步回归分析发现,观察组和对照组术前肥胖(OR=8.63,95%CI=1.35~17.60,P=0.021)、术前低密度脂蛋白低水平(OR=0.81,95%CI=0.23~0.98,P=0.001)、术中淋巴结清扫数目(OR=0.32,95%CI=0.14~0.59,P=0.015)差异有统计学意义,而与其余因素差异均无统计学意义(P>0.05)。结论术前肥胖、术前低密度脂蛋白低水平、淋巴结清扫数目可能是食管癌术后发生食管主动脉瘘的相关因素。

Objective To explore the related risk factors of aortic esophageal fistula （AEF） after esophageal carcinoma oper- ation. Methods According to the design of case-control study and matching proportion of 1 ： 3,18 cases of AEF after esophageal carcinoma operation treated in the thoracic surgery department of Daping Hospital of Third Military Medical University from 2000 to 2015 served as the observation group, and contemporaneous 54 cases of esophageal carcinoma operation, who had approximate basic diseases or risk factors, were selected as the control group, 18 pairs were formed. The risk factors possessed by the observation group before disease onset such as age,sex,tumor TNM stage and tumor location served as the matching variables. The non-matc- hing variables including operation time, preoperative body mass index （BMI）, amount of intraoperative hemorrhage, preoperative LDL level, anastomosis mode, postoperative pulmonary complications, postoperative arrhythmia, preoperative hypertension, preoper- ative diabetes and number of removed lymph nodes were performed the case-control study. Results The univariate Logistic analysis preliminarily screened out 5 risk factors,including preoperative obesity,preoperative LDL level,postoperative pulmonary complica- tions,anstomosis mode and number of removed lymph nodes, the difference in other factors was not statistically significant （P 0. 05）. The multivariate non-conditional Logistic stepwise regression analysis revealed that preoperative obesity （OR = 8. 63, 95 %CI= 1.35- 17.60 ）, preoperative LDL level （OR = 0. 81,95 %CI = 0.23 - 0. 98） and the number of intraoperatively removed lymph nodes （OR= 0. 32.95 %CI =0. 14-0.59） had statistical differences between the observation group and control group, but the difference in other factors had no statistical significance. Conclusion Preoperative obesity, preoperative LDL level and number of removed lymph nodes might be the risk factors for AEF occurrence after esophageal carcinoma operation.