Research on the risk factors of anastomotic fistula after esophageal cancer surgery
-
摘要:目的
探讨食管癌患者术后发生吻合口瘘的危险因素。
方法回顾性分析107例食管癌手术患者的临床资料，将术后发生吻合口瘘的21例患者纳入观察组，将术后未发生吻合口瘘的86例患者纳入对照组，通过单因素分析和多因素Logistic回归分析明确食管癌术后发生吻合口瘘的危险因素。
结果单因素分析结果显示，年龄、低蛋白血症、糖尿病史、术前新辅助治疗、吻合部位均与食管癌术后吻合口瘘有关(P＜0.05); 多因素Logistic回归分析显示，术前接受新辅助治疗是食管癌患者术后发生吻合口瘘的独立危险因素(OR=5.392, 95%CI: 1.335~30.382, P=0.020)。
结论术前接受新辅助治疗是食管癌患者术后发生吻合口瘘的独立危险因素，对于术前合并其他系统疾病尤其是糖尿病、低蛋白血症的高危患者，应做好充分的术前准备。
Abstract:ObjectiveTo investigate the risk factors of anastomotic fistula after esophageal cancer surgery.
MethodsThe clinical data of 107 patients with esophageal cancer surgery were retrospectively analyzed, among whom 21 patients with anastomotic fistula after surgery were included in observation group, and 86 patients without anastomotic fistula after surgery were included in control group. The risk factors of anastomotic fistula after esophageal cancer surgery were identified by univariate analysis and multivariate Logistic regression analysis.
ResultsUnivariate analysis showed that age, hypoproteinemia, history of diabetes, preoperative neoadjuvant therapy, and anastomotic site were associated with anastomotic fistula after esophageal cancer surgery (P < 0.05); multivariate Logistic regression analysis showed that preoperative neoadjuvant therapy was an independent risk factor for postoperative anastomotic fistula in patients with esophageal cancer (OR=5.392; 95%CI, 1.335 to 30.382; P=0.020).
ConclusionPreoperative neoadjuvant therapy is an independent risk factor for postoperative anastomotic fistula in patients with esophageal cancer. For patients with preoperative comorbid diseases, especially diabetes and hypoproteinemia, adequate preoperative preparation should be made.
-
Keywords:
- esophageal cancer surgery /
- anastomotic fistula /
- neoadjuvant therapy /
- hypoalbuminemia /
- diabetes /
- risk factors
-
-
表 1 食管癌术后吻合口瘘的单因素分析[n(%)]
变量 分类 观察组(n=21) 对照组(n=86) χ2 P 性别 男 17(81.0) 47(54.7) 4.857 0.443 女 4(19.0) 39(45.3) 年龄 ＜65岁 13(61.9) 73(84.9) 5.650 ＜0.001 ≥65岁 8(38.1) 13(15.1) 体质量指数 ＜25 kg/m2 16(76.2) 56(65.1) 0.940 0.337 ≥25 kg/m2 5(23.8) 30(34.9) 吸烟史 有 9(42.9) 32(37.2) 0.228 0.130 无 12(57.1) 54(62.8) 肿瘤位置 颈段 2(9.5) 17(19.8) — 0.856 胸上段 5(23.8) 28(32.6) 胸中断 10(47.6) 20(23.2) 胸下段 4(19.1) 21(24.4) 手术方式 开放式手术 7(33.3) 13(15.1) 3.688 0.056 微创手术 14(66.7) 73(84.9) 吻合部位 颈部 16(76.2) 76(88.4) 2.078 0.004 胸内 5(23.8) 10(11.6) 吻合方式 手工吻合 6(28.6) 18(20.9) 0.566 0.323 器械吻合 15(71.4) 68(79.1) 糖尿病史 有 13(61.9) 40(46.5) 1.560 0.006 无 8(38.1) 46(53.5) 低蛋白血症 有 16(76.2) 34(39.5) 9.110 0.041 无 5(23.8) 52(60.5) 术前新辅助治疗 有 11(52.4) 24(27.9) 4.593 ＜0.001 无 10(47.6) 62(72.1) 
下载: 导出CSV
表 2 食管癌术后吻合口瘘的多因素Logistic回归分析
因素 OR 95%CI P 年龄 3.072 0.127~1.074 0.598 术前新辅助治疗 5.392 1.335~30.382 0.020 吻合部位 3.474 1.634~29.823 0.999 低白蛋白血症 2.134 6.212~6.465 0.966 合并糖尿病 1.878 1.464~18.623 0.058
下载: 导出CSV
-
[1] 陈龙奇, 李小飞, 傅剑华, 等. 食管鳞癌术后随访中国胸外科专家共识[J]. 中国胸心血管外科临床杂志, 2022, 29(2): 141-149. [2] HIRANO Y, KONISHI T, KANEKO H, et al. Proportion of early extubation and short-term outcomes after esophagectomy: a retrospective cohort study[J]. Int J Surg, 2023, 109(10): 3097-3106. doi: 10.1097/JS9.0000000000000568
[3] ELLIOTT J A, KLEVEBRO F, MANTZIARI S, et al. Neoadjuvant chemoradiotherapy versus chemotherapy for the treatment of locally advanced esophageal adenocarcinoma in the European multicenter ENSURE study[J]. Ann Surg, 2023, 278(5): 692-700. doi: 10.1097/SLA.0000000000006018
[4] 田烨, 周凌霄, 任光国. 1208例食管癌患者术后吻合口瘘风险因素分析[J]. 重庆医学, 2014, 43(15): 1924-1927. [5] 靳凤梅, 李转梅. 食管癌术后颈部食管胃吻合口瘘的相关影响因素分析[J]. 实用癌症杂志, 2023, 38(1): 133-135. [6] 林振孟, 郑辉哲, 严明芳, 等. 胃癌患者全胃切除术后吻合口瘘的危险因素及其预后[J]. 中华普通外科杂志, 2018, 33(10): 817-820. [7] LOW D E, ALDERSON D, CECCONELLO I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: esophagectomy complications consensus group (ECCG)[J]. Ann Surg, 2015, 262(2): 286-294. doi: 10.1097/SLA.0000000000001098
[8] 苏瑜琛, 张建卫, 蒋勇, 等. 食管癌三切口术后吻合口良性狭窄的危险因素分析[J]. 中华胸部外科电子杂志, 2018, 5(4): 208-212. [9] LORENTZ T, FOK M, WONG J. Anastomotic leakage after resection and bypass for esophageal cancer: lessons learned from the past[J]. World J Surg, 1989, 13(4): 472-477. doi: 10.1007/BF01660760
[10] 杨博, 郝安林, 郭晓锋, 等. 管状胃-食管吻合术联合胸腔镜食管癌切除术对食管癌患者肺功能的影响[J]. 中国临床医生杂志, 2022, 50(12): 1464-1467. [11] 李莉莉, 顾江魁, 李佳, 等. 食管癌术后早期肠内营养耐受与吻合口瘘的相关性探究[J]. 实用临床医药杂志, 2021, 25(24): 48-51. doi: 10.7619/jcmp.20212680 [12] 贾鑑慧, 刘飞, 任翼, 等. 食管癌原黏蛋白α3表达水平与食管癌患者病理特征的关系及其评估预后的价值[J]. 中国临床医生杂志, 2022, 50(5): 577-580. [13] LIU Y J, FAN J, HE H H, et al. Anastomotic leakage after intrathoracic versus cervical oesophagogastric anastomosis for oesophageal carcinoma in Chinese population: a retrospective cohort study[J]. BMJ Open, 2018, 8(9): e021025. doi: 10.1136/bmjopen-2017-021025
[14] 李蕾蕾. 食管癌术后吻合口瘘的非技术性危险因素分析[D]. 苏州: 苏州大学, 2018. [15] GAO H, FENG H M, LI B, et al. Impact of high body mass index on surgical outcomes and long-term survival among patients undergoing esophagectomy: a meta-analysis[J]. Medicine, 2018, 97(28): e11091. doi: 10.1097/MD.0000000000011091
[16] 聂洪鑫, 王兵, 杨思豪, 等. 食管癌术后食管胃吻合口瘘危险因素的系统评价与Meta分析[J]. 中国胸心血管外科临床杂志, 2022, 29(2): 166-178. [17] 聂洪鑫. 围术期食管癌术后食管胃吻合口瘘的危险因素评价与研究[D]. 兰州: 甘肃中医药大学, 2021. [18] SAKURAI K, TAMURA T, TOYOKAWA T, et al. Low preoperative prognostic nutritional index predicts poor survival post-gastrectomy in elderly patients with gastric cancer[J]. Ann Surg Oncol, 2016, 23(11): 3669-3676. doi: 10.1245/s10434-016-5272-6
[19] 张帆. 食管癌术后吻合口瘘的研究进展[D]. 石家庄: 河北医科大学, 2016. [20] 王尧, 黄利荣, 施东辉, 等. 食管癌术后颈部与胸内吻合口瘘发生的影响因素分析[J]. 中国医学工程, 2021, 29(2): 96-99. [21] HONG Z N, XU J X, CHEN Z, et al. Additional neoadjuvant immunotherapy does not increase the risk of anastomotic leakage after esophagectomy for esophageal squamous cell carcinoma: a multicenter retrospective cohort study[J]. Int J Surg, 2023, 109(8): 2168-2178. doi: 10.1097/JS9.0000000000000487
[22] NILSSON M. The combination of respiratory comorbidity and neoadjuvant chemoradiotherapy may double the risk of anastomotic leaks after esophagectomy: do we know enough to tailor neoadjuvant therapies, or take other preemptive measures in high-risk patients[J]. Ann Surg Oncol, 2019, 26(9): 2660-2661. doi: 10.1245/s10434-019-07485-7
[23] ROH S, IANNETTONI M D, KEECH J, et al. Timing of esophagectomy after neoadjuvant chemoradiation therapy affects the incidence of anastomotic leaks[J]. Korean J Thorac Cardiovasc Surg, 2019, 52(1): 1-8. doi: 10.5090/kjtcs.2019.52.1.1
[24] 刘占豪, 耿昕, 李春艳, 等. VFP新辅助化疗方案对局部晚期食管癌手术治疗影响的临床研究[J]. 黑龙江医学, 2014, 38(7): 777-778. [25] 王宝, 曲明江, 邹勤光, 等. 食管癌术后吻合口瘘原因及治疗[J]. 中国老年学杂志, 2017, 37(22): 5634-5635. [26] 刘欣源. 中医医疗服务技术项目基本医疗保险目录准入管理研究[D]. 北京: 中国中医科学院, 2022.
计量
- 文章访问数: 124
- HTML全文浏览量: 27
- PDF下载量: 13
苏公网安备 32100302010246号
