全腹腔镜根治性全胃切除术后食管空肠吻合口漏相关因素分析及吻合方式选择经验探讨

目的探讨全腹腔镜根治性全胃切除术（TLTG）后食管空肠吻合口漏的相关危险因素及吻合方式的选择。 方法回顾性分析2016年1月至2020年12月行TLTG的150例胃癌患者临床资料。采用SPSS 22.0完成数据统计处理，TNM分期及分化程度等级计数资料行秩和检验，其他单因素分析的计数资料行χ²检验，多因素分析行Logistic回归分析。P<0.05为差异有统计学意义。 结果150例TLTG的胃癌患者中，术后发生食管空肠吻合口漏14例（9.3%）。单因素分析结果显示，患者年龄、肺功能不全、术前血清白蛋白（ALB）、术中失血量、术中输血情况及吻合方式是TLTG后食管空肠吻合口漏发生的危险因素（P<0.05）。多因素结果显示，患者年龄≥60岁、肺功能不全、术中输血及圆型吻合器吻合是TLTG后食管空肠吻合口漏发生的独立危险因素（P<0.05）。 结论患者年龄≥60岁、肺功能不全、术中输血及圆型吻合器吻合与TLTG后食管空肠吻合口漏的发生密切相关。因此TLTG术前应积极控制相关危险因素，术中操作严谨细致、选择合适吻合方式，以降低胃癌患者术后吻合口漏的发生。

Related factors of esophagojejunal anastomotic leakage after total laparoscopic gastrectomy and experience of anastomotic mode selection

ObjectiveTo investigate the risk factors of and methods of esophagojejunum leakage after total laparoscopic radical gastrectomy（TLTG）. MethodsThe clinical data of 150 patients with gastric cancer who underwent TLTG from January 2016 to December 2020 were analyzed retrospectively. SPSS 22.0 was used to complete statistical processing of the data. Rank sum test was performed on TNM staging and differentiation grade count data，χ² test was performed on other univariate analysis count data，and Logistic regression analysis was performed on multivariate analysis. P<0.05 was considered statistically significant. ResultsAmong 150 TLTG patients with gastric cancer，esophagojejunal anastomotic leakage occurred in 14 cases（9.3%）. Univariate analysis showed that age，pulmonary insufficiency，preoperative albumin（ALB），intraoperative blood loss，intraoperative blood transfusion and anastomotic method were risk factors for esophagojejunostomy leakage after TLTG（P<0.05）. Multivariate analysis showed that age ≥60 years old，pulmonary dysfunction，intraoperative blood transfusion and anastomat anastomosis were independent risk factors for esophageal and jejunal anastomosis leakage after TLTG（P<0.05）. ConclusionAge ≥60 years old，pulmonary insufficiency，intraoperative blood transfusion and anastomosis with round stapler were closely related to the occurrence of esophagojejunostomy leakage after TLTG. Therefore，preoperative risk factors should be actively controlled before TLTG，and appropriate anastomotic methods should be selected during the operation with rigorous and meticulous operation to reduce the occurrence of postoperative anastomotic leakage in patients with gastric cancer.