全腔镜食管癌根治McKeown术式发生吻合口瘘的危险因素分析

蒋朋朋; 王兴邦; 霍前伦

doi:10.13898/j.cnki.issn.1000-2200.2022.09.019

全腔镜食管癌根治McKeown术式发生吻合口瘘的危险因素分析

Analysis of the risk factors of anastomotic fistula after total endoscopic McKeown radical resection for esophageal cancer

摘要

摘要:
目的探讨全腔镜McKeown术式治疗食管癌术后发生吻合口瘘的危险因素。
方法选取160例采用全腔镜McKeown术式治疗食管癌病人的临床资料，单因素分析病人性别、年龄、饮酒史、吸烟史、糖尿病病史、高血压病史、体质量指数、肿瘤直径、肿瘤位置、术前放化疗、手术时间、吻合方式、是否做管状胃、吻合口是否包埋、吻合口是否悬吊、术后第3天血清白蛋白含量、术后肺部感染及病理学类型与术后吻合口瘘的相关性，多因素logistics回归分析食管癌术后发生吻合口瘘的独立危险因素。
结果160例中，31例发生吻合口瘘，保守治疗后瘘口消失；14例出现吻合口狭窄，经球囊扩张治疗后均好转；无支架植入及死亡病例。单因素分析显示，肿瘤位置(上段)、术前未放化疗、肺部感染及术后第3天血清白蛋白 < 30 g/L的病人在食管癌术后吻合口瘘的发生率较高(P < 0.05~P < 0.01)。多因素logistic回归分析显示，术后第3天血清白蛋白 < 30 g/L和术后肺部感染是食管癌术后发生吻合口瘘的独立危险因素(P < 0.05)。
结论术后血清白蛋白 < 30 g/L和肺部感染是全腔镜食管癌根治McKeown术式后发生吻合口瘘的独立危险因素，通过改善营养状态及控制肺部感染能有效减少吻合口瘘的发生。

Abstract:
ObjectiveTo explore the risk factors of anastomotic fistula after total endoscopic McKeown technique for esophageal cancer.
MethodsThe clinical data of 160 patients with esophageal cancer treated with total endoscopic McKeown technique were selected.The correlation between postoperative anastomotic fistula and gender, age, drinking history, smoking history, diabetes mellitus history, hypertension history, body mass index, tumor diameter, tumor location, preoperative radiotherapy and chemotherapy, operation time, anastomotic mode, making tubular stomach or not, embedding anastomotic site or not, suspending anastomotic site or not, serum albumin content on the third day after, postoperative pulmonary infection, pathological types was analyzed by univariate analysis.The independent risk factors of anastomotic fistula after operation for esophageal cancer were analyzed by multivariate logistic regression analysis.
ResultsAmong the 160 esophageal cancer cases, 31 cases had anastomotic fistula, which disappeared after conservative treatment; anastomotic stenosis occurred in 14 cases, and all improved after balloon dilatation; no stent implantation and death cases were found.Univariate analysis showed that the incidence of anastomotic fistula was higher in patients with tumor location of upper segment, no preoperative radiotherapy and chemotherapy, pulmonary infection and serum albumin < 30 g/L on the third day after operation (P < 0.05 to P < 0.01).Multivariate logistic regression analysis showed that serum albumin < 30 g/L on the third day after operation and postoperative pulmonary infection were the independent risk factors for anastomotic fistula after esophageal cancer operation (P < 0.05).
ConclusionsPostoperative serum content of albumin content < 30 g/L and postoperative pulmonary infection are the independent risk factors for anastomotic fistula after total endoscopic McKeown radical resection for esophageal cancer.The occurrence of anastomotic fistula can be effectively reduced by improving nutritional status and controlling pulmonary infection.

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