食管癌根治术后吻合口难治性狭窄的相关因素分析

Related Factors of Refractory Anastomotic Stenosis after Esophagectomy

目的探讨影响食管癌根治术后吻合口难治性狭窄的相关因素。方法回顾性分析2012年1月~2020年12月蚌埠医学院第一附属医院收治的因食管癌根治术后良性吻合口狭窄行内镜下扩张治疗的130例患者。根据狭窄所需内镜下扩张次数分为难治性狭窄组(扩张次数≥4次)和非难治性狭窄组(扩张次数<4次),采用统计学检验和多因素Logistic回归分析评价影响食管癌根治术后吻合口难治性狭窄的相关因素。结果本研究共纳入130例患者,26例(20%)患者发展为难治性狭窄。单因素分析结果显示,吻合口瘘、狭窄距门齿距离≤25cm、吻合钉/缝线残存、复杂食管狭窄以及食管癌根治术后5个月内出现狭窄可能与食管癌根治术后吻合口难治性狭窄有关(P<0.05)。多因素Logistic回归分析结果显示,吻合口瘘、狭窄距门齿距离≤25cm、复杂食管狭窄以及食管癌根治术后5个月内出现狭窄是食管癌根治术后吻合口难治性狭窄的独立危险因素(P<0.05)。结论吻合口瘘、狭窄距门齿距离≤25cm、复杂食管狭窄以及食管癌根治术后5个月内出现狭窄与食管癌根治术后吻合口难治性狭窄有关。

Objective To investigate the related factors of refractory anastomotic stenosis after esophagectomy.Methods Onehundred and thirty patients in the First Affiliated Hospital of Bengbu Medical College who underwent endoscopic dilation treatment for benign anastomotic stenosis after esophagectomy from January 2012 to December 2020 were retrospectively analyzed.According to the number of endoscopic dilations of stenosis,the patients were divided into refractory stenosis group(dilation times≥4 times)and non-refractory stenosis group(dilation times<4 times),and the related factors affecting refractory anastomotic stenosis after esophagectomy were evaluated by statistical test and multivariate Logistic regression analysis.Results A total of 130 patients were included in this study,and 26(20%)patients developed refractory stenosis.Univariate analysis showed that anastomotic leakage,the distance between stenosis and incisor≤25cm,anastomotic nail/suture residue,complex esophageal stenosis,and development of stenosis within 5months after esophagectomy may be related to the refractory stenosis(P<0.05).Multivariate analysis showed that anastomotic leakage,the distance between stenosis and incisor≤25cm,complex esophageal stenosis,and development of stenosis within 5months after esophagectomy were independent risk factors for refractory stenosis(P<0.05).Conclusion Anastomotic leakage,the distance between stenosis and incisor≤25cm,complex esophageal stenosis,and development of stenosis within 5months after esophagectomy were associated with refractory stenosis.