【摘要】：目的:分析和探討食管癌術(shù)后頸部食管胃吻合口瘺的危險(xiǎn)因素,為臨床預(yù)防頸部食管胃吻合口瘺的發(fā)生提供理論支持。方法:回顧性分析鄭州大學(xué)第一附屬醫(yī)院胸外科2012年1月至2016年12月行食管癌根治食管胃頸部吻合術(shù)的956例患者的臨床資料,根據(jù)術(shù)后有無(wú)出現(xiàn)吻合口瘺分為兩組。通過(guò)查閱文獻(xiàn)和臨床觀察,選取與頸部食管胃吻合口瘺發(fā)生的可能相關(guān)因素,單因素分析篩選出頸部食管胃吻合口瘺發(fā)生的危險(xiǎn)因素,再對(duì)這些危險(xiǎn)因素進(jìn)行Logistic回歸分析篩選出頸部食管胃吻合口瘺發(fā)生的獨(dú)立危險(xiǎn)因素。結(jié)果:117例患者術(shù)后出現(xiàn)頸部食管胃吻合口瘺,吻合口瘺的發(fā)生率為12.2%。單因素分析結(jié)果示:性別、年齡、糖尿病史、手術(shù)方式、制作管狀胃、手術(shù)時(shí)間、術(shù)后肺部感染、術(shù)后纖支鏡吸痰、術(shù)后機(jī)械通氣、術(shù)后ICU治療與頸部食管胃吻合口瘺的發(fā)生相關(guān),兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);吸煙史、飲酒史、高血壓史、心臟病史、腦血管病史、術(shù)前放化療、體重下降、HGB、ALB、BMI、FEV1%、腫瘤分段、手術(shù)出血量、吻合方式、包埋、病理類型、TNM分期、分化程度、淋巴結(jié)清掃數(shù)與吻合口瘺的發(fā)生無(wú)明顯關(guān)系,兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。Logistic回歸分析結(jié)果示:制作管狀胃(OR=1.922,P=0.006)、術(shù)后肺部感染(OR=2.907,P=0.000)、術(shù)后纖支鏡吸痰(OR=2.323,P=0.009)是頸部食管胃吻合口瘺的獨(dú)立危險(xiǎn)因素。結(jié)論:男性、年齡≥65歲、有糖尿病史、腔鏡手術(shù)、制作管狀胃、手術(shù)時(shí)間≥300min、術(shù)后肺部感染、術(shù)后纖支鏡吸痰、術(shù)后機(jī)械通氣、術(shù)后ICU治療是頸部食管胃吻合口瘺的危險(xiǎn)因素;制作管狀胃、術(shù)后肺部感染、術(shù)后纖支鏡吸痰是頸部食管胃吻合口瘺的獨(dú)立危險(xiǎn)因素。圍手術(shù)期對(duì)相關(guān)危險(xiǎn)因素進(jìn)行有效控制和預(yù)防,可降低頸部食管胃吻合口瘺的發(fā)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，

本文編號(hào)：2230275