食管癌患者胸腔镜手术后吻合口瘘致脓胸的影响因素

Influencing Factors of Pyothorax Caused by Anastomotic Leakage in Patients with Esophageal Cancer After Thoracoscopic Surgery

目的 统计食管癌患者胸腔镜手术后吻合口瘘致脓胸发生状况,评估患者发生吻合口瘘致脓胸的影响因素。方法 选取2015年7月至2021年7月在南阳市第二人民医院治疗的508例食管癌术后合并吻合口瘘患者,对患者进行跟踪随访,随访时间截止至2021年9月,统计患者随访期间吻合口瘘致脓胸发生状况,寻找患者发生吻合口瘘致脓胸的影响因素。结果 508例食管癌合并吻合口瘘患者中,中途失访8例,最终纳入500例患者进行研究;500例食管癌合并吻合口瘘患者中,发生脓胸40例,占比为8.00%;发生组术前合并慢性阻塞性肺疾病(COPD)、使用纤维支气管吸痰、术前合并糖尿病、术前血清白蛋白<35 g·L^(-1)占比高于未发生组,差异有统计学意义(P<0.05);两组患者在肿瘤分期、体重指数等方面对比,差异无统计学意义(P>0.05);经logistic回归分析显示,术前合并COPD、使用纤维支气管镜吸痰、术前合并糖尿病、术前血清白蛋白<35 g·L^(-1)是食管癌患者胸腔镜手术后吻合口瘘致脓胸发生的危险因素(OR>1,P<0.05)。结论 食管癌患者胸腔镜手术后吻合口瘘致脓胸的影响因素为术前合并COPD、使用纤维支气管镜吸痰、术前合并糖尿病、术前血清白蛋白<35 g·L^(-1)。

Objective To count the incidence of pyothorax caused by anastomotic leakage in patients with esophageal cancer after thoracoscopic surgery, and to evaluate the influencing factors of pyothorax caused by anastomotic leakage in patients.Methods A total of 508 patients with postoperative anastomotic fistula of esophageal cancer treated in Nanyang Second General Hospital from July 2015 to July 2021 were selected. The patients were followed up until September 2021. The incidence of pyothorax caused by anastomotic leakage during the follow-up period was counted to find out the relevant factors of pyothorax caused by anastomotic leakage.Results Among 508 patients with esophageal cancer complicated with anastomotic leakage, 8 were lost to follow-up, and 500 patients were finally included in the study. Among 500 patients with esophageal cancer complicated with anastomotic leakage, 40 cases developed empyema, accounting for 8.00%. The proportion of patients with chronic obstructive pulmonary disease(COPD), sputum aspiration with fiberoptic bronchus, diabetes and serum albumin <35 g·L^(-1)in the occurrence group was higher than that in the non occurrence group, and the difference was statistically significant(P<0.05). There was no statistical significant difference in tumor stage and body mass index between the two groups(P>0.05). Logistic regression analysis showed that preoperative COPD, sputum aspiration with fiberoptic bronchoscope, preoperative diabetes, and preoperative serum albumin <35 g·L^(-1)were the risk factors for pyothorax caused by anastomotic leakage in patients with esophageal cancer after thoracoscopic surgery(OR>1, P<0.05).Conclusion The influencing factors of pyothorax caused by anastomotic leakage in patients with esophageal cancer after thoracoscopic surgery are preoperative COPD, sputum aspiration with fiberoptic bronchoscope, preoperative diabetes and preoperative serum albumin <35 g·L^(-1).