腹腔镜与开放全胃切除术后食道吻合口瘘危险因素分析

Analysis of Risk Factors of Esophageal Anastomotic Leakage in Gastric cancer Patients after Total Gastrectomy

目的探讨全胃切除术后食管吻合口漏的危险因素,以期为该并发症的预防提供参考。方法回顾性总结2017年1月~2017年12月南京医科大学第一附属医院胃外科收治的221例行腹腔镜或开放根治性全胃切除术(TG)胃癌病人的临床病理学资料,分析影响术后食管吻合口漏(EAL)的危险因素。结果221例病人术后并发EAL11例(4.98%),其中开放手术114例,术后1例出现EAL(1/114,0.88%);腹腔镜手术107例,术后10例出现EAL(10/107,9.36%),差异明显(P=0.004)。单因素分析显示:手术方式、手术时间和术前白蛋白水平是影响全胃切除术后EAL的危险因素(P<0.05)。多因素分析结果显示:手术方式和术前白蛋白水平是影响全胃切除术后EAL的独立危险因素。结论对于术前白蛋白水平偏低的胃癌患者行全胃切除术前应重视营养干预,以减少发生EAL的风险。应用线型切割缝合器行食道空肠吻合的腹腔镜全胃切除术具有较高的食道吻合口瘘风险。

Objective To clarify the risk factors for anastomotic leakage after total gastrectomy(TG)for gastric cancer.Methods In this study,we enrolled 221 patients with preoperatively diagnosed gastric cancer who underwent TG(laparascopic or open gastrectomy)by a single surgeon team between January 2017 and December 2017 at the department of surgery,gastric center,the first affiliated hospital to Nanjing medical university.Risk factors for esophageal anastomotic leakage(EAL)after TG were retrospectively evaluated by univariate and multivariate analyses.Results AEL was observed in 11(4.98%)of 221 patients.Univariate analysis of risk factors revealed that preoperative serum albumin,operation method and operation time were risk factors for EAL.Multivariate analysis revealed that preoperative serum albumin and operation method were independent risk factors for EAL.Conclusion Gastric cancer patients with low preoperative serum albumin or undergo laparascopic total gastrectomy have higher risks for EAL after TG.The results of this study must be confirmed by a study with a large cohort of patients receiving TG by experienced surgeons in multiple institutions.