食管癌切除术后死亡原因及危险因素的多因素logistic回归分析

目的　探讨食管癌切除术后的死亡原因及危险因素。方法　对 1 973年 3月至 2 0 0 0年 6月 1 40 0例行食管癌切除术病例进行研究。将手术死亡 (术后住院期间或 30d以内死亡 )和未死亡的病例各分为一组 ,选择 1 6个可能对食管癌切除术手术死亡率产生影响的特征性因素 ,通过计算机logistic回归模型进行多因素分析。结果　 1 40 0例中手术死亡 31例 ,手术死亡率为 2 .2 %。死亡原因 :呼吸系统并发症 1 7例 (包括肺炎、肺不张导致的呼吸衰竭 1 5例 ,以及成人呼吸窘迫综合征ARDS 2例 ,占死亡组的5 4.8% ) ;吻合口瘘 1 1例 (34.5 % ) ;乳糜胸 2例 (6 .5 % ) ;术后消化道出血 1例 (3.2 % )。影响食管癌手术死亡率的主要危险因素是 :长期重度吸烟史 ,手术持续时间和手术年代 3个指标 (P <0 .0 5 )。结论　欲降低食管癌手术死亡率 ,应提高术前肺功能状况 ,加强围术期处理 ,改善吻合方法和吻合技术 ,及时处理肺部并发症 ,适时适宜的使用机械辅助呼吸

The reason of operative death and operative risk factors in patients with esophageal cancer after esophagectomy by logistic regression model

Objective　To explore the risk factors and causes affecting the operative mortality in esophagectomy patients with esophageal can cer. Methods　1400 cases with a curative esophagectomy for neopl asm of esophagus hospitalized from Mar,1973 to June, 2000 were reviewed. There w ere 31 died within 30 d or during hospitalization after esophagectomy as a group , and 1 369 survival cases, after operation, as another group. Sixteen factors t hat may influence the operational mortality were selected. A multi-variate anal ysis of these individual variables was performed by the computer′s logistic reg ression model. Results　The operative mortality was 2.2%(31/1400 ). The causes of death included respiratory complication 17 cases (including res piratory failure caused by pneumonia or atelectasis), 15 cases, and adult respir atory distress syndrome (ARDS) 2 cases, the mortality was 54.8% in the death gro up), anastomotic leak 11 cases (34.5%), Chylothorax 2 cases (6.5%) and postopera tive digestive tract hemorrhage 1 case (3.2%). The results showed that the major risk factors that affected operative mortality in cases with esophageal cancer were history of long-herm heavy smoking, duration of operation and the year of operational (P<0.05). Conclusion　To minimize operative mort ality of esophagectomy, some means must be noticed, including the reinforcemen t of the perioperative care, the improvement of anastomotic methods and surgical skill, reduing operative time as p ossible, disposing pulmonary complications in time and using respirator if neces sary.