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腹腔镜全胃切除术后食管空肠吻合口漏危险因素分析

Analysis of risk factors and intervention measures of esophagojejunal anastomotic leakage in gastric cancer patients after laparoscopic total gastrectomy
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摘要 目的探讨腹腔镜全胃切除术后食管空肠吻合口漏的危险因素及处理措施。方法回顾性分析2006年4月至2016年12月南方医科大学南方医院收治的440例行腹腔镜全胃切除切缘阴性的胃癌病人的临床病理学资料。对照分析影响术后食管空肠吻合口漏的危险因素及相对应的处理措施。结果 440例病人术后并发食管空肠吻合口漏者12例(2.7%),平均发生时间为术后4(1~8)d。单因素分析显示:性别、年龄、新辅助化疗、吻合方式(全腹腔镜吻合、辅助切口吻合)、联合器官切除(胰体尾、脾脏、胆囊)、侵犯食管是影响腹腔镜全胃切除术后并发食管空肠吻合口漏的危险因素(P<0.05)。多因素分析结果显示:年龄、新辅助化疗、吻合方式、联合器官切除、侵犯食管是影响腹腔镜全胃切除术后并发食管空肠吻合口漏的独立危险因素。结论对高龄(>65岁)、接受新辅助化疗、肿瘤侵犯食管、行全腹腔镜吻合方式、联合器官切除病人,行腹腔镜下全胃切除须警惕食管空肠吻合口漏发生。内镜下覆膜支架置入使食管空肠吻合口漏病人预后快且创伤小,但有脱落风险。 Objective To identify the risk factors of esophagojejunal anastomotic leakage and its intervention measures of gastric cancer patients after laparoscopic total gastrectomy. Methods The clinical and follow-up data of 440 gastric cancer patients who underwent laparoscopic total gastrectomy with negative margins at the Department of General Surgery, Nanfang Hospital of Southern Medical University from April 2006 to December 2016 were analyzed retrospectively. Risk factors of esophagojejunal anastomotic leakage and intervention measures of patients were analyzed respectively. Results Esophagojejunal anastomotic leakage occurred in 12 of 440 patients(2.7%). The leakage was diagnosed at a median of 4(range,1 to 8) days after surgery. Univariate analysis showed that gender, age, neoadjuvant chemotherapy, anastomosis method, combined organ resection, invasion of the esophagus were risk factors affecting esophagojejunal anastomotic leakage after laparoscopic total gastrectomy, with statistically significant differences(P<0.05). Multivariate analysis showed that age, neoadjuvant chemotherapy, anastomosis method, combined organ resection,invasion of the esophagus were independent risk factors affecting esophagojejunal anastomotic leakage after laparoscopic total gastrectomy, with statistically significant differences(P<0.05). Conclusion For the elderly patients, who are older than 65 years old, received neoadjuvant chemotherapy, had tumor invasion of the esophagus, undergone total laparoscopic anastomosis, combined organ resection, when they are treating with laparoscopic total gastrectomy, esophagojejunal anastomosis should be careful about. Esophagojejunal anastomotic leakage can be treated effectively with self-expanding metalstents, but the risk of migration still exists.
作者 罗俊 陈新华 陈粤泓 刘浩 胡彦锋 林填 李团结 赵明利 陈豪 李国新 余江 LUO Jun;CHEN Xin-hua;CHEN Yue-hong(Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Gastrointestinal Surgery,Peking University Shenzhen Hospital,Shenzhen 518036,China)
出处 《中国实用外科杂志》 CSCD 北大核心 2019年第2期168-172,共5页 Chinese Journal of Practical Surgery
基金 吴阶平医学基金会临床科研专项资助基金-卓越外科基金(No.320.2710.1819).
关键词 胃肿瘤 腹腔镜全胃切除术 食管空肠吻合口漏 危险因素 干预 gastric cancer laparoscopic total gastrectomy esophagojejunal anastomotic leakage risk factors intervention
作者简介 通信作者:余江,E-mail:balbcyu@vip.163.com;通信作者:李国新,Email:gzliguoxin@163.com;第一作者:罗俊;第一作者:陈新华.
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