食管癌术后食管胃吻合口狭窄的危险因素及对策  

Risk factors and countermeasures of anastomotic stricture after esophagogastrostomy

作　　者：刘俊宏 施贵冬[1] 付茂勇[1] 周瑜[1] 刘艳[1] 李东林 宁东 Liu Junhong,Shi Guidong,Fu Maoyong,Zhou Yu,Liu Yan,Li Donglin,Ning Dong(Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nan Chong 637000, China)

机构地区：[1]川北医学院附属医院胸外科,南充637000

出　　处：《中华胸部外科电子杂志》2018年第3期159-163,共5页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的分析食管胃吻合术后吻合口狭窄的危险因素,并提出预防措施。方法以2014年6月—2016年6月在川北医学院附属医院胸外科内镜室因吻合口狭窄行吻合口扩张术的食管癌术后患者为实验组(n=138),以1∶2比例随机抽取同期能进食固体食物的食管癌术后患者为对照组(n=276)。通过单因素和多因素分析了解术前体重指数、术前吞咽情况、术前影像学检查有无狭窄、病变位置、手术方式、吻合口位置、吻合方式、肿瘤直径、病理分型、病理分期、术后是否发生吻合口瘘等因素对术后吻合口狭窄的影响。结果单因素分析显示:病理分期和术后吻合口瘘差异均有统计学意义(P<0.05);吻合方式和吻合口位置差异均无统计学意义(P>0.05)。将吞咽困难(P=0.05)、肿瘤直径(P=0.1)、病理分期(P=0.04)、吻合口瘘(P<0.01)纳入Logistic多因素回归分析显示:术后吻合口瘘(OR=5.87,95%CI:2.65～13.01;P<0.01)、肿瘤直径<3cm(OR=1.65,95%CI:1.01～2.67;P=0.04)是吻合口狭窄发生的影响因素;术前吞咽情况亦是吻合口狭窄的影响因素,其中半流质患者相对于流质患者更易发生吻合口狭窄(OR=2.13,95%CI:1.32～3.45;P<0.01)。结论吻合口瘘是食管癌患者术后吻合口狭窄的独立危险因素,早期预防性食管扩张对预防吻合口狭窄非常重要。术前吞咽困难相对较轻、肿瘤直径相对较短及病理分期相对较早的患者更容易发生吻合狭窄,对于这部分患者应采取侧侧吻合,以减少术后吻合口狭窄。Objective To investigate the risk factors of anastomotic stenosis after esophagogastrostomy, and to improve the life quality after esophagogastrostomy.Methods From June 2014 to June 2016, 138 patients （experimental group） with esophageal cancer who underwent anastomotic dilatation due to anastomotic stenosis in our thoracic endoscopy room were retrospectively analyzed, and 276 patients （control group） with esophageal cancer who could eat solid food at the same time were randomly selected. The effects of preoperative body mass index, preoperative swallowing, preoperative imaging examinations on anastomotic stenosis, location of lesion, surgical approach, anastomotic site, anastomotic mode, tumor length, pathological classification, pathological stage, and postoperative anastomotic leakage on postoperative anastomotic stenosis were analyzed by univariate and multivariate analysis.Results Univariate analysis showed that there were significant differences in pathological staging and anastomotic leakage （ P 〈0.05）, and no significant differences in anastomotic mode and location （ P 〉0.05）. Dysphagia （ P =0.05）, tumor length （ P =0.1）, pathological stage （ P = 0.04） and anastomotic fistula （ P 〈0.01） were included in logistic regression analysis, and the results showed that postoperative anastomotic leakage （ OR =5.87, 95% CI ： 2.65-13.01; P 〈0.01）, tumor length which was less than 3 cm （ OR =1.65, 95% CI ： 1.01-2.67; P = 0.04） were the influencing factors of anastomotic stenosis. Preoperative swallowing was also a risk factor for anastomotic stenosis： semifluid patients were more likely to have anastomotic stenosis than fluid patients （ OR =2.13, 95% CI ： 1.32- 3.45 ; P 〈0.01）.Conclusions Anastomotic fistula is an independent risk factor for postoperative anastomotic stenosis. For patients with anastomotic fistula, early prophylactic esophageal dilatation is very important to prevent anastomotic stenosis. According to the results of multivariate anal

关 键 词：食管癌 吻合口狭窄 吻合口瘘 肿瘤直径 

分 类 号：R735.1[医药卫生—肿瘤]