食管癌切除患者颈部不同吻合方式发生吻合口瘘影响因素分析

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摘要目的探讨食管癌切除患者颈部不同吻合方式发生吻合口瘘的影响因素。方法回顾性选取2015年1月至2019年12月自贡市第四人民医院胸外科收治的139例食管癌颈部吻合患者作为研究对象。根据吻合方式将其分为器械吻合组（78例）和手工吻合组（61例）。分析术前及围手术期资料，比较两种吻合方式的吻合口瘘发生率。根据术后有无吻合口瘘将患者分为吻合口瘘组（18例）和无吻合口瘘组（121例），分析影响吻合口瘘的危险因素。结果单因素分析结果显示，肿瘤部位、吻合方式、肿瘤分期、手术时间、新辅助放化疗是吻合口瘘的相关因素（P<0.05）。多因素分析结果显示，器械吻合（β=0.978，OR=20.322，95%CI=1.343~201.434）、手术时间>300 min（β=2.877，OR=1.150，95%CI=1.101~1.893）是吻合口瘘发生的独立危险因素（P<0.05）。139例患者中，器械吻合的吻合口瘘发生率为19.2%，高于手工吻合的4.9%，差异有统计学意义（P<0.05）。器械吻合中，细管状胃的瘘发生率高于球棒状胃，差异有统计学意义（P<0.05）。结论手术时间、吻合方式是吻合口瘘发生的独立危险因素。手工分层吻合能有效减少颈部吻合口瘘的发生，器械吻合时，采用球棒状胃能降低吻合口瘘的发生。手工分层端端吻合具有胃损伤小，吻合口瘘发生率低的优点，是一种较好的颈部吻合方式。

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	唐波
	赵夏
	刘红兵
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	刘奎
	张慧

关键词 ：食管癌切除, 颈部吻合, 吻合口瘘, 端端吻合

Abstract： Objective To explore the influencing factors of anastomotic leakage in different cervical anastomoses in patients with esophageal carcinoma after esophagectomy. Methods A total of 139 cases of patients receiving cervical anastomosis of esophageal carcinoma in Zigong Fourth People′s Hospital from January 2015 to December 2019 were selected retrospectively as research objects. According to different methods of anastomosis, they were divided into manual anastomosis group (61 cases) and mechanical anastomosis group (78 cases). The preoperative and perioperative data were analyzed to compare the incidence of anastomotic leakage between manual anastomosis and mechanical anastomosis. According to the postoperative anastomotic leakage or not, the patients were divided into anastomotic leakage group (18 cases) and non-anastomotic leakage group (121 cases). The risk factors for anastomotic leakage were investigated based on the clinical data. Results The results of univaritate of anastomotic leakage showed that the tumor location, methods of anastomosis, tumor stage, operation time and neoadjuvant chemororadiotherapy were closely associated with anastomotic leakage (P<0.05). Then the results of multivariate analysis showed that mechanical anastomosis (β=0.978, OR=20.322, 95%CI=1.343-201.434), operation time >300 min (β=2.877, OR=1.150, 95%CI=1.101-1.893) were independent risk factors for anastomotic leakage (P<0.05). Among 139 cases of patients, the leakage rate of mechanical anastomosis was 19.2%, which was higher than that in manual anastomosis (4.9%), the difference was statistically significant (P<0.05). In the mechanical anastomosis group, the leakage rate in tubular stomach was higher than the baseball bat-shaped stomach, the difference was statistically significant (P<0.05). Conclusion Operation time and methods of anastomosis are independent risk factors of anastomotic leak. Layered anastomosis could effectively reduce the incidence of anastomotic leakage. Baseball bat-shaped tubular stomach could effectively reduce the incidence of leakage in mechanical anastomosis. End-to-end layered manual anastomos is associated with a lower rate of anastomotic leakage and slight injury in stomach, which is worthy of clinical application.

Key words： Esophagectomy Cervical anastomosis Anastomotic leakage End-to-end layered anastomos

引用本文:

唐波；赵夏；刘红兵；张清峰；刘奎；张慧. 食管癌切除患者颈部不同吻合方式发生吻合口瘘影响因素分析[J]. 中国当代医药, 2022, 29(21): 18-22.
TANG Bo ； ZHAO Xia ； LIU Hongbing ； ZHANG Qingfeng ； LIU Kui ； ZHANG Hui. Analysis of influencing factors of anastomotic leakage in different cervical anastomoses in patients with esophageal carcinoma after esophagectomy. 中国当代医药, 2022, 29(21): 18-22.

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https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2022/V29/I21/18

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