食管癌术后颈部食管胃吻合口瘘的危险因素分析

发布时间：2018-09-08 10:36

【摘要】：目的:分析和探讨食管癌术后颈部食管胃吻合口瘘的危险因素,为临床预防颈部食管胃吻合口瘘的发生提供理论支持。方法:回顾性分析郑州大学第一附属医院胸外科2012年1月至2016年12月行食管癌根治食管胃颈部吻合术的956例患者的临床资料,根据术后有无出现吻合口瘘分为两组。通过查阅文献和临床观察,选取与颈部食管胃吻合口瘘发生的可能相关因素,单因素分析筛选出颈部食管胃吻合口瘘发生的危险因素,再对这些危险因素进行Logistic回归分析筛选出颈部食管胃吻合口瘘发生的独立危险因素。结果:117例患者术后出现颈部食管胃吻合口瘘,吻合口瘘的发生率为12.2%。单因素分析结果示:性别、年龄、糖尿病史、手术方式、制作管状胃、手术时间、术后肺部感染、术后纤支镜吸痰、术后机械通气、术后ICU治疗与颈部食管胃吻合口瘘的发生相关,两组比较差异有统计学意义(P0.05);吸烟史、饮酒史、高血压史、心脏病史、脑血管病史、术前放化疗、体重下降、HGB、ALB、BMI、FEV1%、肿瘤分段、手术出血量、吻合方式、包埋、病理类型、TNM分期、分化程度、淋巴结清扫数与吻合口瘘的发生无明显关系,两组比较差异无统计学意义(P0.05)。Logistic回归分析结果示:制作管状胃(OR=1.922,P=0.006)、术后肺部感染(OR=2.907,P=0.000)、术后纤支镜吸痰(OR=2.323,P=0.009)是颈部食管胃吻合口瘘的独立危险因素。结论:男性、年龄≥65岁、有糖尿病史、腔镜手术、制作管状胃、手术时间≥300min、术后肺部感染、术后纤支镜吸痰、术后机械通气、术后ICU治疗是颈部食管胃吻合口瘘的危险因素;制作管状胃、术后肺部感染、术后纤支镜吸痰是颈部食管胃吻合口瘘的独立危险因素。围手术期对相关危险因素进行有效控制和预防,可降低颈部食管胃吻合口瘘的发生。
[Abstract]:Objective: to analyze and explore the risk factors of cervical esophagogastric anastomotic fistula after esophageal cancer operation, and to provide theoretical support for clinical prevention of cervical esophagogastric anastomotic fistula. Methods: the clinical data of 956 patients undergoing esophagogastrostomy from January 2012 to December 2016 in thoracic surgery of the first affiliated Hospital of Zhengzhou University were analyzed retrospectively. The patients were divided into two groups according to whether there were anastomotic leakage or not. The risk factors of cervical esophagogastric anastomotic fistula were screened by single factor analysis by consulting literature and clinical observation. The independent risk factors of cervical esophagogastrostomy fistula were screened by Logistic regression analysis. Results 117 cases of cervical esophagogastric anastomotic fistula occurred after operation, and the incidence of anastomotic fistula was 12.2%. The results of univariate analysis showed that: sex, age, history of diabetes, operation method, making tube stomach, operation time, postoperative pulmonary infection, postoperative fiberoptic sputum aspiration, postoperative mechanical ventilation, Postoperative ICU treatment was associated with cervical esophagogastric anastomotic fistula (P0.05), smoking history, alcohol consumption history, hypertension history, heart disease history, cerebrovascular disease history, preoperative radiotherapy and chemotherapy, weight loss and weight loss were observed. The amount of bleeding, anastomosis, embedding, pathological type, TNM stage, differentiation degree, number of lymph nodes dissection were not related to the occurrence of anastomotic leakage. There was no significant difference between the two groups (P0.05). Logistic regression analysis showed that making tubular stomach (OR=1.922,P=0.006), postoperative pulmonary infection (OR=2.907,P=0.000) and postoperative sputum aspiration (OR=2.323,P=0.009) were the independent risk factors of cervical esophagogastric anastomotic fistula. Conclusion: male, age 鈮，

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