胸腹腔镜联合食管癌根治术后发生颈部吻合口瘘的影响因素

Risk factors of neck anastomotic fistula after thoracoscopic-laparoscopic esophagectomy for esophageal cancer

目的:探讨胸腹腔镜联合食管癌根治术后发生颈部吻合口瘘的影响因素。方法:回顾性分析2016年3月至2019年3月郑州大学第一附属医院收治的259例行胸腹腔镜联合食管癌根治术患者的临床资料,统计颈部吻合口瘘发生率,采用Logistic行多因素分析术后颈部吻合口瘘的影响因素。结果:259例患者术后发生颈部吻合口瘘41例,发生率为15.83%。术前白蛋白水平低、合并糖尿病、单层手工吻合、病变位于上段、术前进行放化疗、肺部感染是胸腹腔镜联合根治术后发生颈部吻合口瘘的独立危险因素(OR=3.148、1.863、1.755、2.610、2.128,P=0.011、0.005、0.007、0.018、0.001)。结论:术前机体营养不良、手工吻合操作、病变位置、术前治疗、肺部感染、糖尿病是胸腹腔镜联合食管癌根治术后发生颈部吻合口瘘的危险因素。

Objective To investigate the risk factors of neck anastomotic fistula after thoracoscopic-laparoscopic esophagectomy for esophageal cancer.Methods The clinical data of 259 esophageal cancer patients underwent thoracoscopic-laparoscopic esophagectomy in the First Affiliated Hospital of Zhengzhou University from March 2016 to March 2019 were retrospectively selected.The incidence of neck anastomotic fistula was counted.Multivariate analysis of the risk factors of neck anastomotic fistula was performed by Logistic analysis.Results In 259 patients,41 cases of neck anastomotic fistula occurred,the incidence rate was 15.83%.Low preoperative albumin level,diabetes mellitus,single-layer manual anastomosis,lesions located in the upper segment,preoperative radiotherapy and chemotherapy,and pulmonary infection were independent risk factors for neck anastomotic fistula(OR=3.148,1.863,1.755,2.610,2.128,P=0.011,0.005,0.007,0.018,0.001).Conclusions Preoperative body malnutrition,manual anastomosis,lesion location,preoperative treatment,lung infection,and diabetes mellitus are risk factors of neck anastomotic fistula after thoracoscopic-laparoscopic esophagectomy for esophageal cancer.