胃癌行全胃切除术后食管空肠吻合口瘘相关因素及治疗效果分析  

Related factors and therapeutic effect of esophageal⁃jejunum anastomotic fistula after total gastrectomy for gastric cancer patients

作　　者：崔鹏 曹先东[1] CUI Peng;CAO Xiandong(General Surgery Department,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院普外科,安徽合肥230022

出　　处：《安徽医药》2020年第12期2486-2489,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨胃癌行全胃切除术后食管空肠吻合口瘘的相关因素及治疗。方法回顾性分析安徽医科大学第一附属医院2013年7月至2017年10月胃癌行全胃切除术后发生食管空肠吻合口瘘的15例及相应时间段的218例未发生吻合口瘘病人的临床资料,对其进行χ^2检验及logistic回归分析。结果χ^2检验结果显示:食管空肠吻合口瘘的发生与4个因素[合并糖尿病(P<0.001)、术前肺功能不全(P=0.018)、高血压(P=0.040)、围手术期输血(P=0.003)]相关,而与性别、年龄、手术时间、术前白蛋白水平、术前血红蛋白、术中出血量、肿瘤大小、位置、浸润深度、分化程度、有淋巴结转移因素不相关(P>0.05)。logistic回归分析结果显示:合并糖尿病、围手术期输血、术前肺功能障碍是全胃术后食管空肠吻合口瘘的独立危险因素。所有吻合口瘘病人均采用充分引流、抑酸、抑酶、抗感染、营养支持等治疗,2例吻合口瘘处摆放覆膜支架取得良好效果,14例痊愈,1例死亡。结论合并糖尿病、围手术期输血、术前肺功能障碍等影响吻合口愈合;吻合口瘘的治疗以确切引流、抗感染、营养支持等治疗为主,吻合口瘘处置覆膜支架也是一种治疗吻合口瘘较好的方法。Objective To investigate the related factors and treatment of esophageal⁃jejunum anastomotic fistula after total gastrec⁃tomy for gastric cancer patients.Methods The clinical data from July 2013 to October 2017 were collected from General Surgery Department of The First Affiliated Hospital of Anhui Medical University,which contained 15 cases of esophageal⁃jejunum anasto⁃motic fistula and 218 cases without esophageal⁃jejunum anastomotic fistula.Chi⁃square test and multivariate logistic regression anal⁃ysis were performed.Results The analysis of Chi⁃square test showed that esophageal⁃jejunum anastomotic fistula was related with four factors:diabetes mellitus(P<0.001),preoprative pulmonary function incompetence(P=0.018),hypertension(P=0.040),and perioperative blood transfusion(P=0.003),but other factors(gender,age,long operative duration,preoperative albumin level,preoperative hemoglobin,intraoperative blood loss,tumor size,location,depth of invasion,degree of differentiation,and lymph node metastasis)had no significant differences(P>0.05).Multivariate logistic regression analysis showed that diabetes mellitus,periop⁃erative blood transfusion and preoperative pulmonary function incompetence were relatively independent risk factors of esophageal⁃jejunum anastomotic fistula after total gastrectomy.All patients with anastomotic fistula were treated with adequate drainage,acid suppression,enzyme inhibition,anti⁃inflammation,nutritional support and so on.Two patients with anastomotic fistula were treated with covered stent which achieved good results Fourteen cases recovered and one died.Conclusions Diabetes mellitus,periopera⁃tive blood transfusion and preoperative pulmonary function incompetence affect the healing of anastomotic fistula.The treatment of anastomotic fistula is mainly focused on tangible drainage,anti⁃infection,and nutritional support.The treatment of anastomotic fistu⁃la with covered stent is also a better method.

关 键 词：胃肿瘤 胃切除术 吻合口瘘 手术后并发症 危险因素 支架 

分 类 号：R735.2[医药卫生—肿瘤]