| 许峰,于在诚.微创食管癌术后吻合口瘘危险因素的分析[J].安徽医药,2017,21(6):1015-1019. |
| 微创食管癌术后吻合口瘘危险因素的分析 |
| Analysis of risk factors of anastomotic leakage after minimally invasive |
| 投稿时间：2016-09-24 |
| DOI： |
| 中文关键词: 食管癌 微创 食管切除术 吻合口瘘 |
| 英文关键词: Esophageal carcinoma Minimally invasive Esophagectomy Anastomotic leakage |
| 基金项目: |
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| 中文摘要: |
| 目的 比较微创与开放食管癌根治术后吻合口瘘的发生率,并分析微创食管癌根治术后吻合口瘘危险因素。方法 回顾性分析行食管癌根治术的657例食管鳞状细胞癌病人的临床资料。手术方式:开放组包括左经胸食管癌根治术(Sweet)202例,上腹右胸两切口食管癌根治术(Ivor-Lewis)40例,颈胸腹三切口食管癌根治术(McKeown)8例；微创组包括胸腹腔镜联合食管癌根治术颈部吻合(TLE-Neck)242例(其中2例为机器人辅助),胸腹腔镜联合食管癌根治术右胸内吻合(TLE-Chest)80例,胸腹腔镜联合食管癌根治术经口置入钉钻头(OrVil)85例。所有病人均无术前放化疗。定量资料用独立样本t检验,定性资料用χ2检验、χ2分割法和Fisher确切概率法,吻合口瘘危险因素多因素分析用Logistic多因素回归分析。结果 657例病人中,1例因胃残端瘘死亡。术后吻合口瘘开放组8例,微创组42例,两组发生率分别为3.20%(8/250)、10.32%(42/407),差异有统计学意义(P=0.001),总体吻合口瘘发生率为7.61%(50/657),微创组吻合口瘘病人死亡2例,因瘘病死率4.76%(2/42)。微创组单因素分析显示,手术术式、手术时间、吻合口位置、是否做管状胃,吻合口是否悬吊、术后第2天血清白蛋白、术后是否出现肺部并发症不同的病人,术后吻合口瘘发生率差异有统计学意义(χ2=8.919、5.893、6.438、8.020、8.240、16.670、13.994, P=0.012、0.015、0.011、0.005、0.004、＜0.001、＜0.001)。多因素分析显示,术后第2天血清白蛋白＜35 g·L-1、术后肺部并发症是微创食管癌术后吻合口瘘的独立危险因素(P＜0.001、P=0.003,OR=7.265、4.593,95%CI=2.725~19.363、1.656~12.736)。结论 过多采用颈部吻合技术是目前微创食管癌根治术后吻合口瘘发生率高于开放手术的原因之一,颈部吻合技术有待进一步改良；术后早期低蛋白血症及肺部并发症是微创食管癌术后发生吻合口瘘的重要原因。 |
| 英文摘要: |
| Objective To compare the postoperative incidence of anastomotic leakage(AL) between minimally invasive esophagectomy(MIE) and open procedure,and to analyze the risk factors of AL after MIE.Methods Clinical data of 657 esophageal squamous cell carcinoma patients who underwent radical esophagectomy were analyzed retrospectively.With regard to the surgical procedures,Sweet,Ivor-Lewis,McKeown were performed in 202,0,8 patients of the open group(OG) respectively,while thoracolaparoscopic McKeown (TLE-Neck),thoracolaparoscopic Ivor-Lewis (TLE-Chest),thoracolaparoscopic Ivor-Lewis with thrasorally placed anvil (OrVil) were performed in 242,0,85 patients of the MIE group (MG) respectively.None of these patients received preoperative radiochemotherapy.Student′s t-test was used to compare the mean of continuous data,Pearson′s χ2 test and Fisher′s exact test were used to compare categorical data.Multivariable logistic regression model was used for multivariate analysis of the risk factors of AL after MIE.Results Among the 657 patients,one patient was dead of gastric stump leakage.Eight patients of the OG experienced AL,while 42 patients of the MG experienced AL.AL rate of the open group 3.20%(8/250) was lower than that of the MIE group 10.32%(42/407)with statistical significance(P= 0.001).The overall AL rate was 7.61%(50/657).Two patients of the MIE group were dead of AL and the leak-associated mortality was 4.76%(2/42).As to AL rate,univariable analysis showed statistical significance between patients with different surgical approaches,operative time and anastomosis locations,and between patients with and without a gastric tube,with and without suspension around anastomosis,with and without plasma albumin level lower then 35 g·L-1 the 2nd day after MIE and with and without postoperative pulmonary complications(χ2=8.919,5.893,6.438,8.020,8.240,6.670,3.994,P= 0.012,0.015,0.011,0.005,0.004,＜0.001,＜0.001).Multivariate analysis showed that plasma albumin level lower then 35 g·L-1 the 2nd day after MIE(P＜0.001,OR=7.265,5%CI=2.725-19.363) and postoperative pulmonary complications(P=0.003,OR=4.593,95%CI=1.656-12.736) were the independent risk factors of AL after MIE.Conclusion The usage of cevical anastomosis could be one of the reasons making MIE have a higher incidence of AL than the open procedure.Cevical anastomosis technique need to be improved.Low level of plasma albumin early stage after operation and postoperative pulmonary complications were significant reasons for AL after MIE. |
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