食管癌术后颈部食管胃吻合口瘘的危险因素分析  

Risk factors analysis of cervical esophagogastric anastomotic fistula after esophagectomy of esophageal cancer

作　　者：邱龙[1] 李向楠[1] 赵松[1] 赵佳[1] 朱登彦[1] 杨洋[1] 原锋锋 张开上 郑少忠[1] 

机构地区：[1]郑州大学第一附属医院胸外科,450052

出　　处：《中华消化外科杂志》2017年第5期483-489,共7页Chinese Journal of Digestive Surgery

基　　金：河南省科技厅项目（172102310047）

摘　　要：目的探讨影响食管癌术后颈部食管胃吻合口瘘的危险因素。方法采用回顾性病例对照研究方法。收集2012年1月至2016年12月郑州大学第一附属医院收治的956例行颈部食管胃吻合的食管癌根治术患者的临床病理资料。全组患者行Sweet手术或Mckeown手术。观察指标：（1）术中及术后情况。（2）影响术后颈部食管胃吻合口瘘的危险因素分析。（3）随访情况。采用门诊和电话方式进行随访，了解患者颈部食管胃吻合口狭窄情况。随访时间截至2017年2月。正态分布的计量资料采用哥±s表示。单因素分析及计数资料比较采用驴检验或Fisher确切概率法：多因素分析采用Logistic回归模型。结果（1）术中及术后情况：956例患者均成功完成手术，其中Sweet手术107例，Mekeown手术849例；开胸手术336例，胸腔镜手术620例。肿瘤部位：食管上段143例，食管中段627例，食管下段186例。956例患者手术时间为（274±67）min，术中出血量为（210±167）mL，清扫淋巴结数目为（18±11）枚。956例患者中，术后发生颈部食管胃吻合口瘘117例，吻合口瘘的发生率为12．24％（117／956）。117例颈部食管胃吻合口瘘患者中，早期瘘2例，中期瘘110例，晚期瘘5例；两管法（胃管、营养管）治愈12例，三管法（胃管、营养管、胸管或纵隔管）治愈24例，颈部切口拆开换药治愈43例，瘘腔置管冲洗治愈15例，食管支架置入治愈17例。术后院内死亡16例，其中颈部食管胃吻合口瘘患者6例，无颈部食管胃吻合口瘘患者10例。956例患者术后住院时间为（16±11）d，其中颈部食管胃吻合口瘘患者术后住院时间为（39±19）d，无颈部食管胃吻合口瘘患者术后住院时间为（13±6）d。术后病理学检查：鳞癌873例，腺癌9例，其他类型癌74例。TNM分期：0期135例，I期110例，Ⅱ期325例，Ⅲ期376例，Ⅳ期1例，未确定分期10例�Objective To investigate the risk factors of cervical esophagogastric anastomotic fistula after esophagectomy of esophageal cancer. Methods The retrospective case-control study was conducted. The clinicopathological data of 956 patients who underwent esophagectomy and cervical esophagogastrostomy fromJanuary 2012 to December 2016 in the First Affiliated Hospital of Zhengzhou University were collected. Patients underwent Sweet or Mckeown surgery. Observation indicators ： （ 1 ） intra- and post-operative situations ; （2） the risk factors analysis of cervical esophagogastric anastomotic fistula after esophagectomy; （3） follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the esophagogastric anastomotic stenosis of patients up to February 2017. Measurement data with normal distribution were represented as the ＇s. Univariate analysis and comparison of count data were done using the chi-square test or Fisher exact probability method. Multivariate analysis was done using the Logistic regression model. Results （ 1 ） Intra- and post-operative situations： all the 956 patients underwent successful operations, including 107 with Sweet operation and 849 with Mckeown operation. Of 956 patients, 336 received thoracotomy and 620 received thoracoscopic surgery. Tumors located in upper, middle and lower esophagus were respectively detected in 143, 627 and 186 patients. Operation time, volume of intraoperative blood loss and number of lymph node dissected in 956 patients were （274± 67）minutes, （210± 167）mL and 18 ± 11, respectively. Of 956 patients, 117 had cervical esophagogastric anastomotic fistula, with an incidence of anastomotic fistula of 12. 24% （117/956）. Of 117 patients with cervical esophagogastric anastomotic fistula, 2 had early stage fistula, 110 had middle stage fistula and 5 had later stage fistula; 12 were cured by two-tube method （stomach tube and nutrition tube）, 24 were cured by three-tube method （stomach tube, nutr

关 键 词：食管肿瘤 颈部 食管胃吻合口瘘 危险因素 

分 类 号：R735.1[医药卫生—肿瘤]