微创食管癌术后吻合口瘘危险因素分析
发布时间：2018-08-13 20:30
【摘要】：目的分析微创食管切除术后吻合口瘘危险因素,提出有临床意义的微创食管癌术后吻合口瘘预防措施。方法根据纳入标准对2014年12月至2015年11月在安徽医科大学第一附属医院胸外科行微创食管切除术的407例食管鳞状细胞癌患者的临床资料进行回顾性分析。手术方式:胸腹腔镜联合食管癌根治术颈部吻合(TLE-Neck)242例;胸腹腔镜联合食管癌根治术右胸内吻合(TLE-Chest)165例,包括胸腹腔镜Ivor-Lewis术80例,胸腹腔镜联合食管癌根治术经口置入钉钻头(Or Vil术)85例。先对总体407例行微创食管癌根治术的患者,选取性别、年龄、吸烟史、饮酒史、高血压病史、糖尿病病史、上消化道慢性病、BMI值、肿瘤位置、肿瘤最大直径、病理分期、手术时间、是否做管状胃、吻合口位置、吻合口是否加固包埋、吻合口是否悬吊、术后第2天血清白蛋白、术后营养方式、术后肺部并发症19个因素进行吻合口瘘单因素分析,筛选出差异有统计学意义者进行多因素分析,再根据吻合部位分TLE-Neck组和TLE-Chest组分别进行吻合口瘘单因素、多因素分析。采用SPSS16.0进行统计分析,计量资料用两独立样本t检验,计数资料用χ2检验或Fisher确切概率法,吻合口瘘危险因素多因素分析用Logistic多因素回归分析,P0.05为差异有统计学意义。结果407例患者中发生术后吻合口瘘42例,总体吻合口瘘发生率为10.32%(42/407),TLE-Neck组242例,发生吻合口瘘33例,吻合口瘘发生率为13.64%(33/242),TLE-Chest组165例,发生吻合口瘘9例,吻合口瘘发生率为5.45%(9/165),TLE-Neck组术后吻合口瘘发生率高于TLE-Chest组,P=0.008,差异有统计学意义。吻合口瘘确诊时间平均为9.24±4.568天。颈部瘘33例,死亡1例,颈部吻合口瘘相关死亡率为3.03%(1/33),胸内瘘9例,死亡1例,胸内瘘相关死亡率为11.11%(1/9),总体吻合口瘘相关死忘率4.76%(2/42)。总体单因素分析显示,手术时间、是否做管状胃、吻合口位置、吻合口是否悬吊、术后第2天血清白蛋白、术后是否出现肺部并发症不同的患者,术后吻合口瘘发生率差异有统计学意义(χ2=5.893、7.368、7.079、8.240、16.670、13.994,P=0.015、0.007、0.008、0.004、0.001、0.001)。多因素分析显示,术后第二天血清白蛋白35g/L、术后肺部并发症是微创食管癌术后吻合口瘘的独立危险因素(P=0.001、0.002,OR=5.345、4.904,95%CI=1.998~14.301、1.833~13.118)。TLE-Neck组单因素分析显示,手术时间、术后第2天血清白蛋白、术后肺部并发症发生不同的患者,术后吻合口瘘发生率差异有统计学意义(P=0.036、0.001、0.028),Logistic多因素分析显示,术后第2天血清白蛋白35g/L(P=0.001,OR=5.914,95%CI=2.730~12.815),术后出现肺部并发症(P=0.045,OR=3.496,95%CI=1.028~11.884)是TLE-Neck术后吻合口瘘的独立危险因素。TLE-Chest组单因素分析显示,吻合口是否悬吊、术后是否出现肺部并发症不同的患者,术后吻合口瘘发生率差异有统计学意义(P=0.012、0.002),Logistic多因素分析显示,吻合口不悬吊(P=0.028,OR=11.457,95%CI=1.300~100.942),术后出现肺部并发症(P=0.001,OR=14.279,95%CI=2.840~71.801)是TLE-Chest术后吻合口瘘的独立危险因素。结论1.由于颈部吻合时吻合口张力大、血供差,目前TLE-Neck术后吻合口瘘发生率高于TLE-Chest术;2.总体而言,术后第2天血清白蛋白35g/L、术后肺部并发症是微创食管癌术后吻合口瘘的独立危险因素;术后第2天血清白蛋白35g/L、术后肺部并发症是TLE-Neck术后吻合口瘘的独立危险因素;吻合口不悬吊、术后肺部并发症是TLE-Chest术后吻合口瘘的独立危险因素;3.加强围术期呼吸道管理减少肺部并发症发生,术后早期检测并及时补充白蛋白,对预防微创食管癌术后颈部吻合口瘘发生具有重要意义;术中对吻合口进行悬吊固定,加强围术期呼吸道管理减少肺部并发症发生,对预防微创食管癌术后胸内吻合口瘘发生具有重要意义。
[Abstract]:Objective To analyze the risk factors of anastomotic leakage after minimally invasive esophagectomy and to propose the preventive measures of anastomotic leakage after minimally invasive esophagectomy for esophageal cancer. The clinical data were analyzed retrospectively. Surgical procedures included: thoracoscopic and laparoscopic neck anastomosis (TLE-Neck) in 242 cases; right thoracoscopic and laparoscopic right intrathoracic anastomosis (TLE-Chest) in 165 cases, including 80 cases of thoracoscopic Ivor-Lewis operation and 85 cases of thoracoscopic and laparoscopic esophageal cancer radical resection with intraoral nail bit (Or Vil operation). 407 patients underwent minimally invasive radical esophagectomy. Sex, age, smoking history, drinking history, hypertension history, diabetes history, upper gastrointestinal chronic disease, BMI value, tumor location, tumor maximum diameter, pathological stage, operation time, whether to do a tubular stomach, anastomotic site, whether the anastomotic stomosis is reinforced embedding, whether the anastomotic stomosis is suspended, postoperative first Two days serum albumin, postoperative nutrition and 19 factors of postoperative pulmonary complications were analyzed by univariate analysis. Those with significant difference were selected for multivariate analysis. According to the anastomotic site, the patients were divided into TLE-Neck group and TLE-Chest group for univariate and multivariate analysis. Results Among 407 cases, 42 cases had postoperative anastomotic leakage, the overall incidence of anastomotic leakage was 10.32% (42/407), and 242 cases in TLE-Neck group. The incidence of anastomotic leakage was 13.64% (33/242), 165 in TLE-Chest group, 9 in TLE-Chest group, and 5.45% (9/165). The incidence of anastomotic leakage in TLE-Neck group was higher than that in TLE-Chest group (P=0.008), and the difference was statistically significant. One patient died, cervical anastomotic leakage-related mortality was 3.03% (1/33), thoracic fistula-related mortality was 9 cases, 1 case died, thoracic fistula-related mortality was 11.11% (1/9), total anastomotic fistula-related amnesia rate was 4.76% (2/42). The overall univariate analysis showed that the operation time, whether to do a tubular stomach, anastomotic site, whether to suspend anastomotic stomosis, serum albumin 2 days after surgery. The incidence of anastomotic leakage was significantly different in patients with different pulmonary complications (_2 = 5.893, 7.368, 7.079, 8.240, 16.670, 13.994, P = 0.015, 0.007, 0.008, 0.004, 0.001, 0.001). Multivariate analysis showed that the serum albumin level was 35g/L on the second day after surgery, and the postoperative pulmonary complications were anastomotic leakage after minimally invasive esophageal cancer surgery. Independent risk factors (P = 0.001, 0.002, OR = 5.345, 4.904, 95% CI = 1.998-14.301, 1.833-13.118). Univariate analysis of TLE-Neck group showed that the operative time, serum albumin on the second day after surgery, postoperative pulmonary complications occurred in different patients, the incidence of anastomotic leakage after surgery was statistically significant (P = 0.036, 0.001, 0.028), Logistic multivariate analysis showed significant difference. The results showed that serum albumin 35g/L (P = 0.001, OR = 5.914, 95% CI = 2.730 - 12.815) on the 2nd day after operation, pulmonary complications (P = 0.045, OR = 3.496, 95% CI = 1.028 - 11.884) were independent risk factors for anastomotic leakage after TLE-Neck operation. The incidence of anastomotic leakage was statistically significant (P = 0.012, 0.002). Logistic multivariate analysis showed that anastomotic leakage was an independent risk factor for TLE-Chest postoperative anastomotic leakage (P = 0.028, OR = 11.457, 95% CI = 1.300-100.942), and postoperative pulmonary complications (P = 0.001, OR = 14.279, 95% CI = 2.840-71.801). The incidence of anastomotic leakage after TLE-Neck operation is higher than that after TLE-Chest operation. 2. Generally speaking, serum albumin 35 g/L on the second day after operation, postoperative pulmonary complications are the independent risk factors of anastomotic leakage after minimally invasive esophageal cancer surgery; serum albumin 35 g/L on the second day after operation; postoperative pulmonary complications are the postoperative anastomotic leakage after TLE-Neck operation. Fistula independent risk factors; anastomotic not suspended, postoperative pulmonary complications are the independent risk factors of anastomotic leakage after TLE-Chest; 3. Strengthen perioperative respiratory management to reduce the incidence of pulmonary complications, early postoperative detection and timely albumin supplement, to prevent the occurrence of cervical anastomotic leakage after minimally invasive esophageal cancer surgery is of great significance; It is of great significance to suspend and fix the anastomotic stoma and strengthen the management of respiratory tract in perioperative period to reduce the occurrence of pulmonary complications for preventing the occurrence of anastomotic leakage after minimally invasive esophageal cancer surgery.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1
本文编号：2182097
[Abstract]:Objective To analyze the risk factors of anastomotic leakage after minimally invasive esophagectomy and to propose the preventive measures of anastomotic leakage after minimally invasive esophagectomy for esophageal cancer. The clinical data were analyzed retrospectively. Surgical procedures included: thoracoscopic and laparoscopic neck anastomosis (TLE-Neck) in 242 cases; right thoracoscopic and laparoscopic right intrathoracic anastomosis (TLE-Chest) in 165 cases, including 80 cases of thoracoscopic Ivor-Lewis operation and 85 cases of thoracoscopic and laparoscopic esophageal cancer radical resection with intraoral nail bit (Or Vil operation). 407 patients underwent minimally invasive radical esophagectomy. Sex, age, smoking history, drinking history, hypertension history, diabetes history, upper gastrointestinal chronic disease, BMI value, tumor location, tumor maximum diameter, pathological stage, operation time, whether to do a tubular stomach, anastomotic site, whether the anastomotic stomosis is reinforced embedding, whether the anastomotic stomosis is suspended, postoperative first Two days serum albumin, postoperative nutrition and 19 factors of postoperative pulmonary complications were analyzed by univariate analysis. Those with significant difference were selected for multivariate analysis. According to the anastomotic site, the patients were divided into TLE-Neck group and TLE-Chest group for univariate and multivariate analysis. Results Among 407 cases, 42 cases had postoperative anastomotic leakage, the overall incidence of anastomotic leakage was 10.32% (42/407), and 242 cases in TLE-Neck group. The incidence of anastomotic leakage was 13.64% (33/242), 165 in TLE-Chest group, 9 in TLE-Chest group, and 5.45% (9/165). The incidence of anastomotic leakage in TLE-Neck group was higher than that in TLE-Chest group (P=0.008), and the difference was statistically significant. One patient died, cervical anastomotic leakage-related mortality was 3.03% (1/33), thoracic fistula-related mortality was 9 cases, 1 case died, thoracic fistula-related mortality was 11.11% (1/9), total anastomotic fistula-related amnesia rate was 4.76% (2/42). The overall univariate analysis showed that the operation time, whether to do a tubular stomach, anastomotic site, whether to suspend anastomotic stomosis, serum albumin 2 days after surgery. The incidence of anastomotic leakage was significantly different in patients with different pulmonary complications (_2 = 5.893, 7.368, 7.079, 8.240, 16.670, 13.994, P = 0.015, 0.007, 0.008, 0.004, 0.001, 0.001). Multivariate analysis showed that the serum albumin level was 35g/L on the second day after surgery, and the postoperative pulmonary complications were anastomotic leakage after minimally invasive esophageal cancer surgery. Independent risk factors (P = 0.001, 0.002, OR = 5.345, 4.904, 95% CI = 1.998-14.301, 1.833-13.118). Univariate analysis of TLE-Neck group showed that the operative time, serum albumin on the second day after surgery, postoperative pulmonary complications occurred in different patients, the incidence of anastomotic leakage after surgery was statistically significant (P = 0.036, 0.001, 0.028), Logistic multivariate analysis showed significant difference. The results showed that serum albumin 35g/L (P = 0.001, OR = 5.914, 95% CI = 2.730 - 12.815) on the 2nd day after operation, pulmonary complications (P = 0.045, OR = 3.496, 95% CI = 1.028 - 11.884) were independent risk factors for anastomotic leakage after TLE-Neck operation. The incidence of anastomotic leakage was statistically significant (P = 0.012, 0.002). Logistic multivariate analysis showed that anastomotic leakage was an independent risk factor for TLE-Chest postoperative anastomotic leakage (P = 0.028, OR = 11.457, 95% CI = 1.300-100.942), and postoperative pulmonary complications (P = 0.001, OR = 14.279, 95% CI = 2.840-71.801). The incidence of anastomotic leakage after TLE-Neck operation is higher than that after TLE-Chest operation. 2. Generally speaking, serum albumin 35 g/L on the second day after operation, postoperative pulmonary complications are the independent risk factors of anastomotic leakage after minimally invasive esophageal cancer surgery; serum albumin 35 g/L on the second day after operation; postoperative pulmonary complications are the postoperative anastomotic leakage after TLE-Neck operation. Fistula independent risk factors; anastomotic not suspended, postoperative pulmonary complications are the independent risk factors of anastomotic leakage after TLE-Chest; 3. Strengthen perioperative respiratory management to reduce the incidence of pulmonary complications, early postoperative detection and timely albumin supplement, to prevent the occurrence of cervical anastomotic leakage after minimally invasive esophageal cancer surgery is of great significance; It is of great significance to suspend and fix the anastomotic stoma and strengthen the management of respiratory tract in perioperative period to reduce the occurrence of pulmonary complications for preventing the occurrence of anastomotic leakage after minimally invasive esophageal cancer surgery.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1
【参考文献】
相关期刊论文 前10条
1 刘长浩;朱佳;;45例食管癌术后吻合口瘘内镜辅助治疗的临床分析[J];肿瘤学杂志;2016年12期
2 赵宏波;郝安林;王卫杰;;颈部持续负压引流装置治疗食管癌术后颈部吻合口瘘的价值[J];河南外科学杂志;2016年04期
3 傅剑华;谭子辉;;食管癌外科治疗的现状与未来展望[J];中国肿瘤临床;2016年12期
4 高赛;安振月;;食管鳞癌胸腹腔镜Ivor-Lewis术与McKeown术近期疗效对比研究[J];中国医学前沿杂志(电子版);2016年04期
5 庄聪文;翁向群;陈朝阳;杨胜生;曾志勇;王雯;李达周;林宝泉;;自膨式覆膜金属支架治疗食管癌术后颈部吻合口瘘[J];现代肿瘤医学;2016年10期
6 周银杰;赵国芳;沈海波;胡天军;李杰;宋旭;;纵膈引流管在食管癌、贲门癌术后吻合口瘘治疗中的应用[J];现代实用医学;2016年02期
7 梅闪闪;刘继先;吴昊;乌达;谢远财;牟志民;;微创荷包钳法Ivor-Lewis术与McKeown术治疗中下段食管癌的近期疗效分析[J];重庆医科大学学报;2016年01期
8 陈学瑜;袁晓琴;陈中元;;经内镜下注射人纤维蛋白粘合剂治疗7例食管癌术后胸内吻合口漏临床研究[J];癌症进展;2015年06期
9 余才华;李鸿伟;张建斌;谢忠海;张军;;内镜下经瘘口置管冲洗引流治疗食管癌术后胸内吻合口瘘[J];中国高等医学教育;2015年10期
10 陈剑;刘永志;刘建;杜少鸣;;经瘘口插管引流联合“三管法”治疗食管癌、贲门癌术后胸内吻合口瘘[J];实用医学杂志;2015年14期
，本文编号：2182097
本文链接：https://www.wllwen.com/yixuelunwen/zlx/2182097.html
