食管癌外科术后消化道瘘发生的危险因素分析  

Analysis of risk factors for gastrointestinal fistula after esophageal cancer surgery

作　　者：陈桃 杨佳 武振宇 张耀 陈磊 CHEN Tao;YANG Jia;WU Zhen-yu;ZHANG Yao;CHEN Lei(Department of Gastroenterology,First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Epidemiology,Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院消化内科,重庆400038 [2]陆军军医大学流行病学教研室,重庆400038

出　　处：《局解手术学杂志》2024年第5期420-424,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市卫生适宜技术推广项目(2018JSTG022)。

摘　　要：目的探讨食管癌外科术后出现消化道瘘的危险因素。方法回顾性分析在我院接受食管癌切除术的437例患者的临床资料,根据术后是否发生消化道瘘分为研究组(n=157)和对照组(n=280),通过单因素及多因素分析筛选出术后消化道瘘发生的相关危险因素。结果单因素分析结果显示,2组患者在手术时间、吻合部位、肿瘤部位、肿瘤浸润深度、手术方式、胸膜粘连、吻合口加固缝合、术后肺部感染、术后切口感染方面差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,胸膜粘连、手术时间≥4.5 h、术后肺部感染、术后切口感染是术后消化道瘘发生的独立危险因素(P<0.05),吻合口加固缝合、术后首次血红蛋白水平升高是术后消化道瘘发生的独立保护因素(P<0.05)。结论控制手术时间、积极抗感染、切口换药、行吻合口加固缝合以及积极纠正贫血等措施,可能有利于减少食管癌切除术后消化道瘘的发生。Objective To investigate the risk factors for gastrointestinal fistula after esophageal cancer surgery.Methods The clinical data of 437 patients who underwent esophagectomy in our hospital were retrospectively analyzed.According to whether gastrointestinal fistula occurred after operation,they were divided into the study group(n=157)and the control group(n=280).The related risk factors of the ocurrence of postoperative gastrointestinal fistula were screened by univariate and multivariate analyses.Results The results of the univariate analysis showed that there were statistically significant differences of patients between the two groups in terms of operation time,anastomotic site,tumor location,tumor infiltration depth,surgical method,pleural adhesion,reinforcement suture of anastomotic stoma,post-operative pulmonary infection,and postoperative incision infection(P<0.05).Multivariate Logistic regression analysis showed that pleural adhesion,operation time≥4.5 hours,postoperative pulmonary infection,and postoperative incision infection were independent risk factors for the occurence of postoperative gastrointestinal fistula(P<0.05).The reinforcement suture of anastomotic stoma and the increase of the first postoperative hemoglobin level were independent protective factors for the occurrence of postoperative gastrointestinal fistula(P<0.05).Conclusion Controlling operation time,applying active anti-infection measures,implementing dressing changes,taking reinforcement suture of anastomotic stoma,and correcting of anemia may help to reduce the occurrence of gastrointestinal fistulas after esophagectomy.

关 键 词：食管癌 外科手术 消化道瘘 危险因素 

分 类 号：R735.1[医药卫生—肿瘤]