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目的分析胸腹腔镜联合食管癌切除术后发生颈部吻合口瘘的相关因素。方法将2013年7月—2015年12月确诊并行胸腹腔镜联合食管癌切除术的229例食管癌患者分为有吻合口瘘组24例和无吻合口瘘组205例,分析两组临床资料,计量资料采用t检验,计数资料采用χ~2检验,多因素分析釆用Logistic回归,P<0.05为差异有统计学意义。结果术前放和(或)化疗(OR=4.762,9 5%CI为1.253~9.236)、术前血清白蛋白水平(OR=1.592,95%CI为1.301~8.826)、病变位置(OR=2.339,95%CI为1.240~7.832)、吻合途径(OR=3.787,95%CI为2.041~5.169)、术后并发肺部感染(OR=1.447,95%CI为1.024~6.752)是颈部吻合口瘘的危险因素。结论术前放和(或)化疗、术前血清白蛋白水平、病变位置、吻合途径、术后并发肺部感染与胸腹腔镜食管癌切除术后发生颈部吻合口瘘明显相关;胸上段食管癌患者术中经食管床路径上提管状胃,并行预防性气管切开可能降低术后颈部吻合口瘘发生率,胸中下段食管癌应尽可能选择胸内吻合,以减少吻合口瘘。
Objective To analyze the related factors of cervical anastomotic fistula after thoraco-laparoscopy combined with esophageal cancer resection. Methods A total of 229 patients with esophageal cancer diagnosed concurrent thoraco-laparoscopic and esophageal resection between July 2013 and December 2015 were divided into 24 cases with anastomotic fistula and 205 cases without anastomotic fistula. The clinical data of two groups , Measurement data using t test, count data using χ ~ 2 test, multivariate analysis preclude the use of Logistic regression, P <0.05 for the difference was statistically significant. Results Preoperative radiotherapy and / or chemotherapy (OR = 4.762, 95% CI 1.253-9.236), preoperative serum albumin level (OR = 1.592, 95% CI 1.301-8.826) (OR = 3.787, 95% CI: 2.041-5.169). Postoperative pulmonary infection (OR = 1.447, 95% CI: 1.024-6.752) Risk factors for fistula. Conclusions Preoperative radiotherapy and / or chemotherapy, preoperative serum albumin level, pathological location, anastomosis approach, postoperative pulmonary infection and thoracoscopic laparoscopic esophagectomy were significantly associated with cervical anastomotic leakage. The upper esophagus Cancer patients on the path of esophageal tube to mention tubular stomach, parallel prophylactic tracheostomy may reduce the incidence of neck anastomotic fistula, lower thoracic esophageal cancer should be selected intrathoracic anastomosis to reduce anastomotic fistula.