| 车 云,王亚龙,谭锋维.930例食管癌术后颈部吻合口瘘危险因素分析[J].中国肿瘤,2018,27(12):956-961. |
| 930例食管癌术后颈部吻合口瘘危险因素分析 |
| Risk Factors of Cervical Anastomosis Leakage After Esophagectomy in Patients with Esophageal Cancer |
| 投稿时间：2018-10-17 |
| DOI：10.11735/j.issn.1004-0242.2018.12.A011 |
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| 中文关键词: 食管肿瘤 手术 颈部吻合口瘘 危险因素 |
| 英文关键词:esophageal neoplasms surgery cervical anastomotic leakage risk factor |
| 基金项目:国家自然科学基金（81871885）；国家重点研发计划（2018YFC1315000/2018YFC1315003）；北京市科技计划（Z181100001718212，Z161100000116044）；中国医学科学院医学与健康科技创新工程（2017-I2M-1-005）；中国医学科学院肿瘤医院院所科研课题（LC2017A01，LC2017D01）；中央保健专项资金（W2017BJ39）；北京协和医学院协和青年科研基金（2017320013）；国家科技支撑计划（2015BAI12B08）；首都临床特色应用研究（Z151100004015188） |
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| 中文摘要: |
| 摘 要：［目的］ 探讨食管癌根治术后颈部吻合口瘘的独立危险因素。［方法］ 回顾性分析930例接受食管癌根治术并行颈部吻合患者的临床病理资料。详细记录患者各项围术期指标，分析患者发生颈部吻合口瘘的危险因素。［结果］ 患者颈部吻合口瘘的发生率为16.1%（150/930），颈部吻合口瘘相关死亡率为0.6%。单因素分析结果显示，一秒用力呼气容积与用力肺活量比值、一氧化碳弥散量占预计值比值、胸部手术史、腹部疾病史、慢性阻塞性肺疾病、外周血管疾病史、胰岛素使用、美国麻醉医师协会（ASA）分级、降主动脉钙化、腹腔干钙化、肝动脉钙化、术后使用呼吸机、二次开胸、呼吸衰竭、术后声嘶均与食管癌术后发生颈部吻合口瘘相关（P<0.05）。多因素Logistic分析结果显示一氧化碳弥散量占预计值比值、腹部疾病史、外周血管疾病史、降主动脉钙化以及术后使用呼吸机为食管癌术后发生颈部吻合口瘘的独立危险因素（P<0.05）。［结论］ 食管癌根治术后颈部吻合口瘘的发生和多种因素密切相关，关注这些因素并做好围术期管理，可减少颈部吻合口瘘发生，避免出现严重的术后并发症。 |
| 英文摘要: |
| Abstract：［Purpose］ To investigate the risk factors of cervical anastomosis leakage after esophagectomy in patients with esophageal carcinoma. ［Methods］ The clinical and pathological data of 930 esophageal cancer patients with cervical anastomosis were retrospectively reviewed. The risk factors of cervical anastomotic leakage were analyzed. ［Results］ The incidence of cervical anastomotic leakage was 16.1%(150/930). The anastomotic leakage-related mortality rate was 0.6%. Univariate analysis showed that the ratio of forced expiratory volume to forced vital capacity in one second(FEV1.0/FVC)，the diffusing capacity of the lung for carbon monoxide(DLCO) predicted，prior chest surgery，prior abdominal disease，chronic obstructive pulmonary disease(COPD)，peripheral vascular disease，insulin use，American Society of Anesthesiologists(ASA) grading，descending aortic calcification，celiac calcification，hepatic artery calcification，postoperative ventilator，secondary operation，respiratory failure，postoperative hoarseness were all associated with cervical anastomotic leakage(P<0.05). Multivariate regression analysis showed that the DLCO predicted，prior abdominal disease，peripheral vascular disease，descending aortic calcification，and postoperative ventilator were independent risk factors of cervical anastomotic leakage after esophagectomy(P<0.05). ［Conclusion］ The occurrence of cervical anastomosis leakage after esophagectomy is closely related to various factors. Strengthening the perioperative prevention and management of risk factors can reduce the incidence of cervical anastomotic leakage and avoid serious postoperative complications. |
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