食管癌三切口术后吻合口良性狭窄的危险因素分析

目的探讨食管癌患者行三切口食管切除术(McKeown术)颈部吻合后发生吻合口良性狭窄的危险因素。 方法回顾性分析2016年9月至2017年8月在上海市胸科医院单一治疗组中行McKeown术，以管状胃代食管的所有食管癌患者，以术后出现良性吻合口狭窄并进行连续扩张次数≥3次的患者为狭窄组，无术后狭窄或狭窄较轻扩张次数<3次的患者为非狭窄组，对两组患者的一般情况、ASA评分、手术方式、吻合方式、管胃上提部位、肿瘤R0切除情况、吻合口瘘等进行统计分析，分析吻合口狭窄的危险因素。 结果共入选271例患者，有9.6%的患者需要行3次或3次以上的扩张治疗。单因素分析显示，高龄(>70岁)、术前新辅助治疗、手工吻合、胸骨后管胃上提路径、吻合口瘘、肿瘤的非R0切除与严重的吻合口狭窄均有相关性(P<0.05)。多因素logistic回归分析结果显示，吻合口瘘(OR＝5.541，95% CI：2.110～14.549，P＝0.001)和胸骨后管胃上提路径(OR＝6.736，95% CI ：1.623～27.965，P＝0.009)是严重吻合口狭窄的独立危险因素。 结论吻合口瘘、胸骨后上提路径是食管癌McKeown手术颈部吻合术后出现吻合口狭窄的独立危险因素。

An analysis of risk factors for benign anastomotic stenosis after McKeown esophagectomy for esophageal cancer

ObjectiveTo investigate the risk factors of benign anastomotic stenosis after neck anastomosis in patients with esophageal cancer undergoing three-incision esophagectomy (Mckeown surgery). MethodsThe data of patients who underwent Mckeown esophagectomy with tubular stomach for esophageal cancer in Shanghai Chest Hospital from September 2016 to August 2017 were selected and retrospectively analyzed. Patients with benign anastomotic stenosis after surgery and enduring 3 times or more dilations after operation were selected as the stenosis group. Patients with less than 3 times dilations or without dilatation were selected as the control group. In both group, each patient’s basic condition, ASA score, surgical method, reconstruction route, location of tubular stomach, R0 resection of tumor , anastomotic leakage were used to analyze the risk factors for anastomotic stenosis. ResultsAmong the 271 patients, 9.6% of them had 3 times dilations or more. By univariate analyses, the factors including elder age(>70) , preoperative neoadjuvant therapy, hand suture anastomosis, retrostrernal reconstruction route, anastomotic leakage , whether achieving R0 resection or not are all related to severe anastomotic stenosis(P<0.05). However by multivariate logistic regression analyses, the condition of anastomotic leakage(OR=5.541, 95% CI: 2.110-14.549, P=0.001)and retro-strernal reconstruction route(OR=6.736, 95% CI : 1.623-27.965, P=0.009)are two independent risk factors for severe anastomotic stenosis. ConclusionsAnastomotic leakage and retrostrernal reconstruction route are two independent risk factors for anastomotic stenosis after cervical anastomosis in esophageal cancer.