食管癌术后颈部与胸内吻合口瘘发生的影响因素分析

Clinical treatment and risk factors of cervical anastomotic leakage and intrathoracic anastomotic leakage after radical esophagectomy

目的研究比较食管癌根治术后胸内与颈部吻合口瘘发生原因及临床诊治措施。方法回顾性分析2017年8月至2019年4月在盐城市第一人民医院行食管鳞状细胞癌根治术患者的400例临床资料。其中,经左胸食管癌根治术90例,右胸腹二切口食管癌根治术110例,全腔镜食管癌根治术(左颈吻合)200例。用x^(2)检验和Logistic回归模型对食管癌术后吻合口瘘发生的危险因素进行单因素和多因素分析。结果400例患者中,术后发生吻合口瘘26例(6.5%)。其中,颈部吻合口瘘19例(2例并发胸内瘘),胸内吻合口瘘7例(1例出现食管气管瘘)。通过对食管癌术后发生吻合口瘘的单因素分析,结果显示手术方式、吻合口位置、手术时间、吻合口是否包埋、术后第2天血清白蛋白是否≥35 g/L及术后是否并发肺部并发症为患者发生吻合口瘘的影响因素(P<0.05)。通过将食管癌术后发生吻合口瘘的单因素分析中差异有统计学意义的指标进行多因素Logistic回归分析,结果显示手术方式、吻合口位置、术后第2天血清白蛋白、术后肺部并发症是食管癌术后吻合口瘘的独立危险因素(P<0.05)。结论过多的采用颈部吻合会增加吻合口瘘的发生率,同时术后低蛋白血症及术后肺部并发症是食管癌术后吻合口瘘的发生重要因素。

【Objective】To analyze and compare the risk factors and clinical diagnosis and treatment of anastomotic leakage in the chest and neck after radical resection of esophageal cancer.【Methods】The clinical data of 400 squamous cell carcinoma patients underwent radical esophagectomy in Yancheng NO.1 Hospital from August 2017 to April 2019 was analyzed retrospectively,including 90 cases completed by Sweet,110 cases completed by Ivor-Lewis,200 cases completed by total laparoscopic radical esophagectomy(left neck anastomosis).Univariate and multivariate analysis of risk factors for postoperative anastomotic leakage in esophageal cancer were performed usingχ^(2) test and logistic regression model.【Results】Of the 400 patients,26 patients had anastomotic leakage after operation,with an incidence of 6.5%.There were 19 cases of cervical anastomotic leakage,2 cases of internal thoracic fistula;7 cases of intrathoracic anastomotic leakage,and 1 case of contralateral pleural fistul.The univariate analysis showed that the surgical procedure,anastomotic location,operation time,whether the anastomosis was embedded,whether plasma albumin level was≥35 g/L on the second postoperative day,and whether postoperative pulmonary complications occurred were influencing factors for anastomotic leakage in patients(P<0.05).Logistic regression model analysis showed that the surgical procedure,anastomotic position,plasma albumin level on the 2nd day after operation,and postoperative pulmonary complications were the independent risk factors for postoperative anastomotic leakage in esophageal cancer(P<0.05).【Conclusion】The excessive usage of cevial anastomosis could increase the incidence of anastomotic leakage,and postoperative hypoproteinemia and postoperative pulmonary complications were important factors in the occurrence of anastomotic leakage after esophageal cancer surgery.