食管癌术后吻合口狭窄扩张后再狭窄的影响因素分析

Risk factors of restenosis after dilation of anastomotic stricture postesophagectomy

目的分析食管癌术后吻合口狭窄扩张治疗后再狭窄的危险因素。方法将94例食管癌术后吻合口狭窄行扩张治疗患者作为研究对象,收集人口学特征、术前临床特征、扩张方法以及扩张后结果等资料并建立数据库,所有患者术后随访6个月,根据随访期内是否再发吻合口狭窄分为再狭窄组和无再狭窄组,采用单因素和多因素Logistic回归分析法,探讨扩张治疗后再狭窄的影响因素。结果随访期间,5例出现吻合口肿瘤复发、2例失访而剔除研究,其余87例患者中再发狭窄51例(再狭窄组),无再发狭窄36例(无再狭窄组)。单因素分析结果显示,吻合口位置、扩张方法、首次扩张后吻合口直径、有无出血以及进食时间可能与食管癌术后吻合口狭窄扩张后再狭窄有关(P﹤0.05)。多因素Logistic回归分析结果显示,吻合口位于气管分叉上方、首次扩张后吻合口直径﹤12 mm是食管癌术后吻合口狭窄扩张后再狭窄的危险因素,而扩张后出血以及术后12 h内进食是食管癌术后吻合口狭窄扩张后再狭窄的保护因素(P﹤0.05)。结论食管癌术后吻合口狭窄首次扩张治疗应尽量将吻合口直径扩张至12 mm以上,尤其是对于高位吻合口,在不引起大量出血的前提下,应鼓励早期进食。

Objective To analyze the risk factors of restenosis after dilation of anastomotic stricture following esophagectomy.Method A total of 94 cases of esophageal cancer patients undergoing post-esophagectomy dilation for anastomotic stricture were included in this study,the demographic characteristics,preoperative clinical characteristics,dilatation procedure and outcomes were recordedto establish adatabase.All patients were followed up for 6 months,and were categorized by whether they had developed restenosis during the follow-up period as two groups;univariate and multivariate Logistic regression analysis was employed to explore the risk factors of restenosis after dilation.Result During the follow-up period,5 patients had recurrence of anastomotic tumor,2 were lost to follow-up and were removed from analysis,among the remaining 87 patients,51 patients had restenosis(restenosis group) and 36 patients had no restenosis(non-restenosis group).Univariate analysis showed that there were statistically significant correlation of anastomosis site,dilatation procedure,anastomosis diameter after first dilatation,presence or absence of blood loss and time to feeding and the occurrence of restenosis after dilation of anastomotic stricture after esophagectomy(P<0.05).Multi-factor Logistic regression analysis revealed that,anastomosis above the tracheal bifurcation and with diameter <12 mm after the first dilation were risk factors for restenosis,while bleeding after dilation and feeding within 12 h after operation were protective factors for restenosis(P<0.05).Conclusion The anastomotic stenosis should be dilated to more than 12 mm in diameter in the first esophageal dilation following esophagectomy,especially for anastomotic stenosis located in the upper part of esophagus,and early feeding is recommended provided that no massive bleeding is induced.