围术期食管癌术后食管胃吻合口瘘的危险因素及预测模型的建立

Risk factors and prediction model of perioperative esophagogastric anastomotic leakage after esophageal cancer surgery

目的分析食管癌术后食管胃吻合口瘘的危险因素,并建立预测模型,为其早期防治提供理论依据。方法收集中国人民解放军联勤保障部队第940医院2013年1月—2020年10月期间收治的行食管癌手术患者的临床资料。根据术后是否发生吻合口瘘,将患者分为吻合口瘘组与非吻合口瘘组。采用单因素及多因素logistic回归分析评估术后吻合口瘘的独立危险因素,建立nomogram临床预测模型。结果纳入患者303例,其中男267例、女36例,平均年龄(62.30±7.36)岁。术后吻合口瘘的发生率为15.2%(46/303)。多因素logistic回归分析显示:高血压、慢性支气管炎、消化道溃疡、手术方式、淋巴结清扫数量、吻合方式、术中胸腔引流管数量、肿瘤位置、术后前3 d未补充白蛋白、术后肺部感染、术后使用纤维支气管镜是食管癌术后食管胃吻合口瘘发生的独立危险因素(P<0.05)。Nomogram预测模型的受试者工作特征曲线下面积为0.954[95%CI(0.924,0.975)],表明预测价值较高。结论本研究根据围术期11项危险因素建立的临床预测模型具有较好的评估效能,可促进食管癌术后食管胃吻合口瘘的早期发现及诊治。

Objective To analyze the risk factors for esophagogastric anastomotic leakage(EGAL)after esophageal cancer surgery,and to establish a risk prediction model for early prevention and treatment.Methods Clinical data of patients undergoing esophagectomy in our hospital from January 2013 to October 2020 were retrospectively analyzed.The independent risk factors for postoperative EGAL were analyzed by univariate and multivariate logistic regression analyses,and a clinical nomogram prediction model was established.According to whether EGAL occurred after operation,the patients were divided into an anastomotic fistula group and a non-anastomotic fistula group.Results A total of 303 patiens were enrolled,including 267 males and 36 females with a mean age of 62.30±7.36 years.The incidence rate of postoperative EGAL was 15.2%(46/303).The multivariate logistic regression analysis showed that high blood pressure,chronic bronchitis,peptic ulcer,operation way,the number of lymph node dissected,anastomotic way,the number of intraoperative chest drainage tube,tumor location,no-supplementing albumin in the first three days after operation,postoperative pulmonary infection,postoperative use of bronchoscope were the independent risk factors for EGAL after esophageal cancer surgery(P<0.05).A prognostic nomogram model was established based on these factors with the area under the receiver operating characteristic curve of 0.954(95%CI 0.924-0.975),indicating a high predictive value.Conclusion The clinical prediction model based on 11 perioperative risk factors in the study has a good evaluation efficacy and can promote the early detection,diagnosis and treatment of EGAL.