基于累积评分的食管癌术后吻合口瘘的风险分级系统

目的建立食管恶性肿瘤术后吻合口瘘并发症的风险分级系统，为食管癌切除术后发生胃食管吻合口瘘风险分级，识别潜在的高危患者。 方法回顾性收集2010年1月至2015年1月于北京朝阳医院胸外科接受食管癌手术患者的临床资料，共285例食管癌患者被纳入分析。对术后胃食管吻合口瘘的潜在危险因素进行单因素分析和Logistic多因素回归分析，确定影响食管恶性肿瘤术后吻合口瘘的独立预测因素；并根据预测因素的权重进行赋值，最终建立食管恶性肿瘤术后吻合口瘘并发症的风险分级系统。 结果全组患者术后食管胃吻合口瘘发生率为9.5%(27/285)，院内病死率为2.8% (8/285)。Logistic多因素回归分析发现，颈部吻合、年龄>69岁及血浆白蛋白<25 g/L是食管癌术后吻合口瘘的独立危险因素。每个独立危险因素均赋值1分，根据患者累积评分进行分组，其中0、1、2、3分组术后吻合瘘的发生率分别为2.2%、7.4%、21.0%和37.5%。 结论食管恶性肿瘤术后吻合口瘘风险分级系统，临床可操作性强，可识别食管癌术后吻合口瘘的高危患者。

An aggregate score system to stratify the risk of anastomotic leakage after esophageal carcinoma surgery

ObjectiveTo develop an aggregate score system to stratify the risk of anastomotic leakage after esophageal carcinoma surgery so as toscreen the patients with high risk for post-operative anastomotic leak. MethodsThe clinical data of patients undergoing esophageal carcinoma surgery in Department of Thoracic Surgery, Beijing Chaoyang Hospital between January 2010 and January 2015 were retrospectively collected, and a total of 285 patients were included for analysis. The independent risk factors for anastomotic leak after surgery were determined by univariate analysis and multivariate Logistic regression analysis. The scoring system was developed by proportional weighing of the independent risk factors, and patients were grouped into different classes according to their total score. ResultsThe incidence of anastomotic leak after operation was 9.5%(27/285), and the in-hospital mortality was 2.8%(8/285). Multivariate Logistic regression analysis revealed that the site of anastomosis(neck), age (>69 years) and hypoalbuminemia (<25 g/L) were independently correlated with anastomotic leak after esophageal carcinoma surgery. With each risk factor receiving weighted score of 1, the patients were divided into 4 groups with an increased incidence of anastomotic leak: score 0 group, 2.2%; score 1 group, 7.4%; score 2 group, 21.0%; and score 3 group, 37.5%. ConclusionsThe aggregate score system is a reliable and practical tool for identifying patients with high risk of developing anastomotic leak after esophageal carcinoma surgery.