西北地区三个医学中心食管癌根治术后患者发生吻合口瘘的风险分析

蒙锦莹1 ，王培礼2, 3 ，肖国栋2 ，任宏2 ，许崇文4 ，刘大鹏2 ，牛云霞5

（1.咸阳市第一人民医院肿瘤外科，陕西 咸阳，712000；2.西安交通大学第一附属医院胸外二科，陕西 西安，710061； 3.河南省人民医院胃肠外科，河南 郑州，450003；4.西安交通大学第一附属医院耳鼻喉头颈外科， 陕西 西安，710061；5.咸阳市第一人民医院病理科，陕西 咸阳，712000）

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摘要：

目的 评估西北地区三个医学中心食管癌根治术后患者发生吻合口瘘的风险因素。方法 回顾性分析西北地区三个医 学中心接受食管癌根治手术的544例患者的临床资料，分析患者相关基础疾病及围手术期处理策略与术后吻合口瘘发生率的关系。结果 入组患者来源的3家医院均具有一定的区域代表性。544例患者术后吻合口瘘发生率为9.2%（50/544），发生瘘的平均时间为（6.4±1.02）d，无死亡。食管癌根治术后吻合口瘘单因素分析结果显示，患者年龄、糖尿病、术前血清白蛋白水 平、呼吸系统疾病、吻合部位及手术时间均与食管癌根治术后吻合口瘘有关（P<0.05）。多因素Logistic 回归分析结果显示，术前合并糖尿病、呼吸系统疾病、术前血清清蛋白水平低、手术时间逸4 h 是食管癌患者根治术后发生吻合口瘘的独立危险因素（P<0.05）。Spearman 相关分析结果显示，肠内营养开始时间与吻合口愈合情况及术后第7天血清白蛋白浓度均呈现正相 关（P<0.05）。结论 合并有糖尿病、高血压、呼吸系统疾病、低白蛋白血症及较长手术时间的患者更易发生食管吻合口的愈合不良，术后早期进行肠内营养支持治疗，有利于吻合口愈合及术后第7天血清白蛋白水平的恢复。

关键词：食管癌根治术；吻合口瘘；风险分析

中图分类号：R735.1文献标志码：A文章编号：2096-1413(2017)26-0003-03

Risk analysis and prevention method discussion on anastomotic fistula of esophageal carcinoma after curative resection in three medical centers of northwest China
MENG Jin-ying 1, WANG Pei-li 2, 3, XIAO Guo-dong 2, REN Hong 2, XU Chong-wen 4, LIU Da-peng 2, NIU Yun-xia 5
(1. Department of Surgical Oncology, the First People``s Hospital of Xianyang City, Xianyang 712000; 2. Department of No.2 Thoracic Surgery, the First Affiliated Hospital of Xi``an Jiaotong University, Xi``an 710061; 3. Department of Gastrointestinal Surgery,
Henan Provincial People``s Hospital, Zhengzhou 450003; 4. Department of Otolaryngology-Head and Neck Surgery,
the First Affiliated Hospital of Xi``an Jiaotong University, Xi``an 710061; 5. Department of Pathology,
the First People``s Hospital of Xianyang City, Xianyang 712000, China)

ABSTRACT: Objective To evaluate the risk factors of anastomotic fistula in patients receiving radical surgery for esophageal carcinoma. Methods The clinical data of 544 patients in three medical centers of northwest China were retrospectively analyzed, to analyze the relationship among basic chronic diseases together with different strategies applied in perioperative and anastomotic fistula incidence. Results Patients in this three medical centers had certain regional representation. The incidence of postoperative anastomotic fistula in the 544 patients was 9.2% (50/544), the mean time of anastomotic fistula was (6.4 ±1.02) d, with no death. Single -factor analysis showed that the age, diabetes mellitus, preoperative serum albumin level, respiratory disease, anastomosis site and operation time were correlated with the anastomotic fistula of esophageal carcinoma after curative resection (P<0.05). Multivariate Logistic regression analysis showed that diabetes mellitus, respiratory disease, low serum albumin level and operation time ≥4 h were the independent risk factors for anastomotic fistula of esophageal carcinoma after curative resection (P<0.05). Spearman correlation analysis showed that the start time of enteral nutrition had positive correlation with heal of anastomotic fistula and the serum albumin levels at 7th day (P<0.05). Conclusion Esophageal anastomotic fistula is more likely to happen in patients with diabetes, respiratory disease, lower serum albumin and long time operation, while earlier supportive enteral nutrition after surgery can help to anastomotic healing and resection of serum albumin at 7th day.
KEYWORDS: esophageal carcinoma after curative resection; anastomotic fistula; risk analysis

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