食管癌术后吻合口漏危险因素分析

Analysis of risk factors for anastomotic Leakage of esophageal cancer patients after radical esophagectomy

目的 探讨食管癌术后吻合口漏的相关危险因素及其治疗方法。方法 2009年1月~2016年1月间收治的食管癌手术病人684例,对其临床资料进行回顾性分析。将可能影响食管癌病人术后吻合口漏发生的17个因素纳入研究,包括临床相关因素与肿瘤相关因素。结果 单因素分析结果显示,术前血清白蛋白水平、手术方式、吻合口位置以及肿瘤TNM分期与食管癌病人术后吻合口漏发生密切相关(P<0.05),多因素Logistic回归分析显示,术前血清白蛋白水平及肿瘤TNM分期是食管癌术后吻合口漏发生的独立危险因素(P<0.05)。术前血清白蛋白水平<35 g/L的病人吻合口漏发生率为21.2%(7/33),白蛋白≥35 g/L的病人吻合口漏发生率为6.6%(43/651),差异有统计学意义(P<0.05)。Ⅲ期食管癌病人术后吻合口漏发生率为9.8%(31/315),明显高于0+Ⅰ+Ⅱ期病人的5.1%(19/369),差异有统计学意义(P<0.05)。结论 术前血清白蛋白水平及肿瘤TNM分期是食管癌术后吻合口漏发生的独立危险因素。

Objective To explore the related risk factors and treatment strategies of anastomotic leakage after radical esophagectomy.Methods A total of 684 patients with esophageal cancer who were treated in our hospital from January 2009 to January 2016 were retrospectively analyzed.Seventeen factors that might affect the occurrence of postoperative anastomotic leakage were included in the study, mainly including clinical and tumor related factors.Results Preoperative serum albumin levels, surgical methods, anastomotic position, and tumor TNM stage were closely related to postoperative anastomotic leakage in patients with esophageal cancer(P<0.05).Multivariate logistic regression analysis revealed that preoperative serum albumin levels and tumor TNM stage are independent risk factors(P<0.05).The incidence of anastomotic leakage was 21.2%(7/33) in patients with serum albumin level <35 g/L and 6.6%(43/651) in patients with albumin level ≥ 35 g/L,the difference was statistically significant(P<0.05).The incidence of anastomotic leakage in patients with TNM stage Ⅲ was 9.8%(31/315),which was significantly higher than that of 5.1%(19/369) in patients with stage 0+Ⅰ+Ⅱ(P<0.05).Conclusion Preoperative serum albumin levels and tumor TNM stage are independent risk factors of postoperative anastomotic leakage in patients with esophageal cancer.