食管切除颈部消化道重建术后吻合口良性狭窄形成的影响因素  

Risk factors of benign anastomostic strictures after esophagectomy with cervical reconstruction

作　　者：钟胜[1] 吴清泉[1] 孙苏安[1] 谷彪[1] 赵铭[1] 陈其友[1] 

机构地区：[1]南京医科大学附属淮安第一医院胸外科,江苏淮安223300

出　　处：《中华胃肠外科杂志》2014年第9期877-880,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：探讨食管切除颈部消化道重建术后吻合口良性狭窄形成的影响因素。方法回顾性分析2003-2012年间在南京医科大学附属淮安医院接受食管癌切除术并行颈部消化道重建的946例食管癌患者的临床资料。吻合口良性狭窄定义：出现吞咽困难症状、经内镜证实需内镜扩张治疗，同时排除经病理证实的恶性病变。分别应用χ^2检验和Logistic回归分析来明确与吻合口良性狭窄形成相关的危险因素。结果156例（16．5％）患者术后出现颈部吻合口良性狭窄。单因素分析显示，心血管病史（P＝0．001）、糖尿病病史（P＝0．041）、管状胃重建（P＝0．050）、端端吻合（P＝0．013）及术后出现吻合口瘘（P＝0．008）与术后吻合口良性狭窄发生有关。多因素分析显示，心血管病史（P＝0．004）、管状胃重建（P＝0．026）、端端吻合（P＝0．043）及术后吻合口瘘（P＝0．001）为吻合口良性狭窄形成的独立影响因素。结论食管切除管状胃颈部重建具有较高的吻合口良性狭窄发生率。对于具有心血管病史者，应维持术后血压的稳定；尽量避免行端端吻合；对于术后吻合口瘘者，在瘘口愈合后可考虑尽早行内镜扩张以预防吻合口狭窄的形成。Objective To identify the risk factors of benign cervical anastomotic strictures after esophagectomy. Methods Clinical data of 946 esophageal cancer patients undergoing esophagectomy with cervical anastomosis between 2003 and 2012 were analyzed retrospectively. Benign stricture was defined as dysphagia for which endoscopic dilation of the anastomosis was needed. Histologically proven malignant stricture was not regarded as benign stricture. χ^2 test and logistic regression model were used for univariate and multivariate analysis respectively. Results A total of 146 patients（16.5%） developed benign stricture during follow-up. Univariate analysis showed that the patients with cardiovascular disease （P=0.001）, diabetes mellitus（P=0.041）, gastric tube reconstruction（P=0.050）, end-to-end anastomosis （P=0.013）, or postoperative anastomotic leakage （P=0.008） had higher stricture rate. Multivariate analysis revealed that cardiovascular disease （P=0.004）, gastric tube reconstruction （P=0.026）, end-to-end anastomosis （P=0.043）, and postoperative anastomotic leakage （P=0.001） were independently predictive factors for development of benign stricture. Conclusions The benign cervical stricture rate after esophagetomy with cervical gastric anastomosis is quite high. In order to prevent benign stricture formation, end-to-end anastomosis should be avoid. Blood pressure should be controlled for those with cardiovascular disease. Endoscopic dilation in an earlier stage postoperatively should be considered for those who develop anastomotic leakage.

关 键 词：食管肿瘤 食管切除术 颈部吻合 吻合口狭窄 

分 类 号：R735.1[医药卫生—肿瘤]