食管癌根治术后行非计划再次手术25例原因分析:单手术组连续1395例手术总结

Cause analysis of 25 unplanned reoperations after radical resection of esophageal cancer:Summary of 1395 consecutive cases in thoracic surgery group

目的探讨食管癌根治术后行非计划再次手术的临床原因,以期对减少食管癌根治术后非计划再次手术发生获得更深层次的理解及认识。方法回顾性分析河北医科大学第四医院胸外科单手术组行食管癌根治术患者1395例的临床资料,其中男性1012例,女性383例,平均年龄(64.21±7.27)岁。肿瘤位于颈段食管1例,胸上段食管154例,胸中段食管589例,胸下段食管651例。病理分期:Ⅰ~Ⅱ期782例(56.06%),Ⅲ~ⅣA期613例(43.94%)。结果1395例行食管癌根治术患者中有25例(1.79%)患者因不同原因导致术后行非计划再次手术。对纳入患者的临床资料进行单因素分析,非计划手术组年龄≥65岁、体重指数<18、病理分期Ⅲ~ⅣA期、吸烟比例高于正常手术组,差异有统计学意义(P<0.05)。将上述因素纳入多因素Logistic回归分析结果显示,年龄≥65岁(OR=0.38,95%CI:0.161~0.896,P=0.027)、体重指数<18(OR=0.176,95%CI:0.062~0.498,P=0.001)、吸烟(OR=0.314,95%CI:0.128~0.771,P=0.011)是食管癌根治术后行非计划再次手术的独立影响因素。造成非计划再次手术的主要原因为吻合口瘘(7/25,28%)、肺部严重并发症(7/25,28%)、术后出血(6/25,24%)。结论高龄、体重指数偏低、吸烟是造成食管癌根治术后非计划再次手术的高危因素。其主要原因包括吻合口瘘、肺部严重并发症、术后出血。对于术前评估高危患者而言,降低非计划再次手术发生概率的关键是提升围手术期管理,降低患者术前营养风险,做好预防监管工作。

Objective To explore the clinical causes of unplanned reoperations after radical resection of esophageal cancer,in order to gain a deeper understanding of reducing the occurrence of unplanned reoperation after radical resection of esophageal cancer.Methods The clinical data of 1395 patients who underwent radical resection for esophageal cancer in thoracic surgery group of the Fourth Hospital of Hebei Medical University were retrospectively analyzed,including 1012 males and 383 females,with an average age of(64.21±7.27)years.The tumors were located in the cervical esophagus in 1 case,the upper thoracic esophagus in 154 cases,the middle thoracic esophagus in 589 cases,and the lower thoracic esophagus in 651 cases.Pathological stage included 782 cases(56.06%)in stageⅠtoⅡ,613 cases(43.94%)in stageⅢtoⅣA.Results In total,25 cases(1.79%)of 1395 patients who underwent radical resection for esophageal cancer had unplanned reoperation for different reasons.Univariate analysis of clinical data of included patients showed that age≥65 years,body mass index(BMI)<18,pathological stageⅢ-ⅣA and smoking rate in the non-planned operation group were higher than those in the normal operation group,and the difference was statistically significant(P<0.05).The above factors were included in multivariate Logistic regression analysis,and the results showed that age≥65 years(OR=0.38,95%CI:0.161-0.896,P=0.027),BMI<18(OR=0.176,95%CI:0.062-0.498,P=0.001)and smoking(OR=0.314,95%CI:0.128-0.771,P=0.011)were independent influencing factors for patients undergoing unplanned reoperation after radical resection of esophageal cancer.Anastomotic fistula(7/25,28%),severe pulmonary complications(7/25,28%),and postoperative bleeding(6/25,24%)were the main causes of unplanned reoperation.Conclusion Advanced age,low BMI and smoking are high risk factors for unplanned reoperation after radical resection of esophageal cancer,and the main causes include anastomotic fistula,severe pulmonary complications and postoperative bleeding.For preoperative assessment of high-risk patients,the key to reducing the probability of unplanned reoperation is to improve perioperative management,reduce preoperative nutritional risks,and ensure prevention and supervision.