术前血Hcy、白蛋白水平对食管癌患者围手术期并发吻合口瘘的影响  

Impact of preoperative serum Hcy and albumin levels on perioperative anastomotic leakage in patients with esophageal cancer

作　　者：冯娟[1] 柏萍[1] 李娟[2] 张艳[3] 冯天悦 肖文明[1] FENG Juan;BAI Ping;LI Juan;ZHANG Yan;FENG Tianyue;XIAO Wenming(Department of Tumor Surgery,Taian City Central Hospital,Shandong,Taian 271000,China;Nursing Office,Bixiahu Branch,Taian City Central Hospital,Shandong,Taian 271000,China;Department of Thoracic and Esophageal Surgery,Taian City Central Hospital,Shandong,Taian 271000,China)

机构地区：[1]山东省泰安市中心医院肿瘤外科,山东泰安271000 [2]山东省泰安市中心医院碧霞湖院区护理办,山东泰安271000 [3]山东省泰安市中心医院胸部与食道外科,山东泰安271000

出　　处：《中国医药科学》2024年第22期134-137,共4页China Medicine And Pharmacy

基　　金：2022年泰安市科技创新发展项目(政策引导类)(2022NS264)。

摘　　要：目的探讨术前血同型半胱氨酸(Hcy)、白蛋白水平对食管癌患者并发症吻合口瘘的影响。方法本研究共纳入泰安市中心医院2017年1月至2023年12月行食管癌根治术的患者303例,观察在术后发生早中期吻合口瘘的发生率,观察性别、年龄、术前血白蛋白、血Hcy、血白细胞、食管癌位置、糖尿病、冠心病、颈动脉斑块、快速康复外科(ERAS)、消化道溃疡、降主动脉钙化等指标,并进行多因素logistic回归分析。结果本研究食管癌围手术期早中期吻合口瘘的发生率为8.91%,单因素分析结果显示年龄、血白蛋白、血Hcy指标比较,差异有统计学意义(P<0.05)。性别、血红蛋白、血白细胞计数、食管癌位置、合并糖尿病、合并冠心病、合并颈动脉斑块、ERAS、消化道溃疡、降主动脉钙化等与吻合口瘘发生无显著相关,差异均无统计学意义(P>0.05)。经多因素logistic回归分析,结果显示术前血白蛋白(OR=0.75,P=0.000)、血Hcy(OR=1.07,P=0.010)是发生吻合口瘘的独立因素。结论降低术前血Hcy水平、改善低白蛋白血症等对于降低食管癌围手术期早中期吻合口瘘的发生具有重要意义。Objective To investigate the impact of preoperative blood homocysteine(Hcy)and albumin levels on anastomotic leakage in patients with esophageal cancer.Methods In this research,a total of 303 patients who underwent radical resection of esophageal cancer in Taian City Central Hospital from January 2017 to December 2023 were included.The incidence of anastomotic leakage in the early and middle stages after operation was observed.The indices such as gender,age,preoperative serum albumin,blood Hcy,white blood cells,esophageal cancer location,diabetes,coronary heart disease,carotid plaque,enhanced recovery after surgery(ERAS),digestive tract ulcer and calcification of descending aorta were observed,and multivariate logistic analysis was conducted.Results The incidence of anastomotic leakage in the early and middle stages of perioperative esophageal cancer in this group was 8.91%.The results of the univariate analysis showed that there were all statistically significant differences in age,blood albumin,and blood Hcy(P<0.05).Gender,hemoglobin,white blood cell count,location of esophageal cancer,complicated diabetes,complicated coronary heart disease,complicated carotid plaque,ERAS,digestive tract ulcer,calcification of descending aorta,etc.were not significantly related to the occurrence of anastomotic leakage,without statistically significant differences(P>0.05).Multifactor logistic analysis results showed that preoperative albumin(OR=0.75,P=0.000)and blood Hcy(OR=1.07,P=0.010)were independent factors for the occurrence of anastomotic leakage.Conclusion Reducing preoperative blood Hcy level and improving hypoalbuminemia are of great significance in reducing the occurrence of anastomotic leakage in early and middle stages of the esophageal cancer perioperative period.

关 键 词：食管癌 围手术期 吻合口瘘 同型半胱氨酸 白蛋白 

分 类 号：R735.1[医药卫生—肿瘤]