微創(chuàng)食管癌術后吻合口瘺危險因素分析
發(fā)布時間：2018-08-13 20:30
【摘要】：目的分析微創(chuàng)食管切除術后吻合口瘺危險因素,提出有臨床意義的微創(chuàng)食管癌術后吻合口瘺預防措施。方法根據(jù)納入標準對2014年12月至2015年11月在安徽醫(yī)科大學第一附屬醫(yī)院胸外科行微創(chuàng)食管切除術的407例食管鱗狀細胞癌患者的臨床資料進行回顧性分析。手術方式:胸腹腔鏡聯(lián)合食管癌根治術頸部吻合(TLE-Neck)242例;胸腹腔鏡聯(lián)合食管癌根治術右胸內吻合(TLE-Chest)165例,包括胸腹腔鏡Ivor-Lewis術80例,胸腹腔鏡聯(lián)合食管癌根治術經(jīng)口置入釘鉆頭(Or Vil術)85例。先對總體407例行微創(chuàng)食管癌根治術的患者,選取性別、年齡、吸煙史、飲酒史、高血壓病史、糖尿病病史、上消化道慢性病、BMI值、腫瘤位置、腫瘤最大直徑、病理分期、手術時間、是否做管狀胃、吻合口位置、吻合口是否加固包埋、吻合口是否懸吊、術后第2天血清白蛋白、術后營養(yǎng)方式、術后肺部并發(fā)癥19個因素進行吻合口瘺單因素分析,篩選出差異有統(tǒng)計學意義者進行多因素分析,再根據(jù)吻合部位分TLE-Neck組和TLE-Chest組分別進行吻合口瘺單因素、多因素分析。采用SPSS16.0進行統(tǒng)計分析,計量資料用兩獨立樣本t檢驗,計數(shù)資料用χ2檢驗或Fisher確切概率法,吻合口瘺危險因素多因素分析用Logistic多因素回歸分析,P0.05為差異有統(tǒng)計學意義。結果407例患者中發(fā)生術后吻合口瘺42例,總體吻合口瘺發(fā)生率為10.32%(42/407),TLE-Neck組242例,發(fā)生吻合口瘺33例,吻合口瘺發(fā)生率為13.64%(33/242),TLE-Chest組165例,發(fā)生吻合口瘺9例,吻合口瘺發(fā)生率為5.45%(9/165),TLE-Neck組術后吻合口瘺發(fā)生率高于TLE-Chest組,P=0.008,差異有統(tǒng)計學意義。吻合口瘺確診時間平均為9.24±4.568天。頸部瘺33例,死亡1例,頸部吻合口瘺相關死亡率為3.03%(1/33),胸內瘺9例,死亡1例,胸內瘺相關死亡率為11.11%(1/9),總體吻合口瘺相關死忘率4.76%(2/42)�？傮w單因素分析顯示,手術時間、是否做管狀胃、吻合口位置、吻合口是否懸吊、術后第2天血清白蛋白、術后是否出現(xiàn)肺部并發(fā)癥不同的患者,術后吻合口瘺發(fā)生率差異有統(tǒng)計學意義(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)。多因素分析顯示,術后第二天血清白蛋白35g/L、術后肺部并發(fā)癥是微創(chuàng)食管癌術后吻合口瘺的獨立危險因素(P=0.001、0.002,OR=5.345、4.904,95%CI=1.998~14.301、1.833~13.118)。TLE-Neck組單因素分析顯示,手術時間、術后第2天血清白蛋白、術后肺部并發(fā)癥發(fā)生不同的患者,術后吻合口瘺發(fā)生率差異有統(tǒng)計學意義(P=0.036、0.001、0.028),Logistic多因素分析顯示,術后第2天血清白蛋白35g/L(P=0.001,OR=5.914,95%CI=2.730~12.815),術后出現(xiàn)肺部并發(fā)癥(P=0.045,OR=3.496,95%CI=1.028~11.884)是TLE-Neck術后吻合口瘺的獨立危險因素。TLE-Chest組單因素分析顯示,吻合口是否懸吊、術后是否出現(xiàn)肺部并發(fā)癥不同的患者,術后吻合口瘺發(fā)生率差異有統(tǒng)計學意義(P=0.012、0.002),Logistic多因素分析顯示,吻合口不懸吊(P=0.028,OR=11.457,95%CI=1.300~100.942),術后出現(xiàn)肺部并發(fā)癥(P=0.001,OR=14.279,95%CI=2.840~71.801)是TLE-Chest術后吻合口瘺的獨立危險因素。結論1.由于頸部吻合時吻合口張力大、血供差,目前TLE-Neck術后吻合口瘺發(fā)生率高于TLE-Chest術;2.總體而言,術后第2天血清白蛋白35g/L、術后肺部并發(fā)癥是微創(chuàng)食管癌術后吻合口瘺的獨立危險因素;術后第2天血清白蛋白35g/L、術后肺部并發(fā)癥是TLE-Neck術后吻合口瘺的獨立危險因素;吻合口不懸吊、術后肺部并發(fā)癥是TLE-Chest術后吻合口瘺的獨立危險因素;3.加強圍術期呼吸道管理減少肺部并發(fā)癥發(fā)生,術后早期檢測并及時補充白蛋白,對預防微創(chuàng)食管癌術后頸部吻合口瘺發(fā)生具有重要意義;術中對吻合口進行懸吊固定,加強圍術期呼吸道管理減少肺部并發(fā)癥發(fā)生,對預防微創(chuàng)食管癌術后胸內吻合口瘺發(fā)生具有重要意義。
[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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1
本文編號：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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1
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