根治性全胃切除术后食管-空肠吻合口瘘危险因素及预后分析  

Analysis of risk factors and prognosis of esophagojejunal anastomotic leakage in gastric cancer patients after curative total gastrectomy

作　　者：柳金强 洪流[1] 杨学文[1] 刘震[1] 连肖[1] 郭曼[1] 周威[1] 张磊[1] 肖书傲 刘书尚 奈超[1] 张洪伟[1] 

机构地区：[1]第四军医大学附属西京医院消化病院消化外科,西安710032

出　　处：《中华胃肠外科杂志》2016年第7期756-762,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（31100643）

摘　　要：目的探讨根治性全胃切除术后食管-空肠吻合口瘘（EJAL）发生的危险因素及其对患者预后的影响。方法回顾性收集西安第四军医大学附属西京医院消化外科2012年1月至2015年5月间行根治性全胃切除手术治疗的1254例胃癌患者临床及随访资料，分别分析EJAL发生的危险因素及影响全组患者预后的因素。根据预后因素分析结果，将发生EJAL的患者与未发生EJAL者行gmatch完全配对。在减小组间其他与预后有关因素差异的前提下，比较有无EJAL患者的生存情况。结果1254例患者术后发生EJAL者31例（2．5％），平均发生时间为术后6（4～12）d。多因素分析显示，术前低血清白蛋白水平（〈35g／L）（P=0．018）、肺功能不全（P=0．006）和手术时间长（≥240min）（P=0．001）是发生EJAL的独立危险因素。全组患者术后随访3～40（中位数18）月。多因素分析结果显示，年龄（≥65岁，P=0．000）、术中输血（P=0．016）、EJAL（P=0．000）、肿瘤部位（下部，P=0．020；全胃，P=0．001）、浸润深度（T4期，P=0．005）和淋巴结转移（N2期，P=0．002；N3期，P=0．000）是影响预后的危险因素。将发生EJAL的患者与未发生EJAL的患者按1：4行gmatch完全匹配成功26对．EJAL组患者术后3年总体生存率44．3％，显著低于无EJAL组的66．7％，差异有统计学意义（P=0．002）。结论根治性全胃切除术患者术后发生EJAL可显著影响预后。围手术期应注意术前血清白蛋白水平偏低、肺功能不全和手术时间长的患者，以防发生EJAL。Objeetlve To identify the risk factors of esophagojejunal anastomotic leakage （EJAL） and its impact on prognosis of gastric cancer patients after curative total gastreetomy. Methods Clinical and follow-up data of 1254 gastric cancer patients who underwent radical total gastrectomy at the Department of Digestive Surgery, Xijing Hospital, from January 2012 to May 2015 were retrospectively collected. Risk factors of EJAL and prognostic factors of patients were analyzed respectively. In order to reduce the influences of other prognostic factors on survival, patients with and without EJAL were selected using Gmatch methods based on the results of prognostic factor analysis. Survival of those with or without EJAL was examined before and after match respectively. Results EJAL occurred in 31 of 1 254 patients（2.5%）. The leakage was diagnosed at a median of 6 （range, 4-12） days after surgery. Multivariate analysis demonstrated that preoperative low serum albumin（〈35 g/L） （P = 0.018）, pulmonary insufficiency （P = 0.006）, long duration of operation（≥240 min） （P= 0.001）were independent risk factors of EJAL. All the patients were followed up for 3 - 40（median 18） months. Multivariate analysis showed that age （≥ 65, P = 0.000）, intraoperative blood transfusion （P = 0.016）, EJAL （P = 0.000）, tumor location （distal, P = 0.020; total, P = 0.001）, depth of invasion （T4, P = 0.005） and lymph node metastasis （N2, P=0.002, N3, P=0.000） were prognostic predictors. Twenty- six patients with EJAL were successfully matched to 104 patients without EJAL in a ratio of 1：4 ratio. Patients with EJAL had a significantly worse overall 3-year survival rate than those without （44.3% vs. 66.7%, P = 0.002）. Conclusions EJAL after curative total gastreetomy leads to worse survival. Patients with preoperative low serum albumin, pulmonary insufficiency and long duration of operation should be taken care of during perioperative period to prevent the occurrence of EJAL.

关 键 词：胃肿瘤 全胃切除术 根治性 食管-空肠吻合口瘘 危险因素 预后 

分 类 号：R735.2[医药卫生—肿瘤]