食管癌术后颈部吻合口瘘的危险因素分析

目的分析食管癌术后吻合口瘘发生的原因,评估其风险因素。方法回顾性分析我科2010年1月至2016年12月期间收治的1328例行食管癌根治术患者的临床资料,其中男726例、女602例,平均年龄(67.2±14.1)岁。根据术后有无吻合口瘘发生,将患者分为两组,吻合口瘘组(167例)和无吻合口瘘组(1161例)。对术后发生吻合口瘘的相关危险因素进行单因素及多因素logistic回归分析。结果吻合口瘘发生率12.6%(167/1328)。单因素分析表明:体重指数、心律失常、慢性阻塞性肺疾病(COPD)、糖尿病、术前白蛋白水平、术前化疗、术前放化疗、病变位置、吻合方式、吻合口包埋、术后并发肺部感染均与颈部吻合口瘘发生相关(P<0.05)。而多因素logistic回归分析显示:术前COPD、病变位置及术后并发肺部感染是术后颈部吻合口瘘发生的独立危险因素(P<0.05)。结论食管癌术后发生颈部吻合口瘘与多种因素相关,术前COPD、病变位置及术后并发肺部感染是术后吻合口瘘发生的独立高风险因素。

Analysis of risk factors of cervical anastomotic leakage after esophageal cancer operation

Objective To analyze the risk factors of anastomotic leakage after esophagectomy. Methods Theclinical data of 1 328 patients with esophageal cancer, who underwent esophagectomy in the First Affiliated Hospital ofHenan University of Science and Technology from January 2010 to December 2016, were retrospectively analyzed. Therewere 726 males and 602 females, at an average age of 67.2±14.1 years. According to whether there was anastomotic leakageafter operation, patients were divided into two groups: an anastomotic leakage group (167 patients) and a nonanastomotic leakage group (1 161 patients). Univariate and multivariate logistic regression analysis was used to identifyrelated risk factors of anastomotic leakage after operation. Results The incidence of postoperative anastomotic leakagewas 12.6% (167/1 328). Univariate analysis showed that body mass index, arrhythmia, chronic obstructive pulmonarydisease (COPD), diabetes, preoperative albumin level, preoperative chemotherapy and chemoradiotherapy, lesionlocation, anastomosis types and postoperative pulmonary infection were associated with statistically significant increase inrisk of cervical anastomotic leakage (P<0.05). Logistic regression analysis showed that preoperative COPD, lesion locationand postoperative pulmonary infection were independent risk factors of cervical anastomotic leakage after esophagectomy(P<0.05). Conclusion The occurrence of cervical anastomotic leakage after esophageal cancer is related to many factors.The preoperative COPD, the lesion location and the postoperative pulmonary infection are independent high risk factors.Paying attention to these factors and doing perioperative management can effectively reduce the occurrence ofanastomotic leakage.