食管癌根治术后发生吻合口难治性狭窄的危险因素分析

Risk factors for refractory anastomotic stricture after esophagectomy

摘要:

目的 探讨食管癌根治术后发生吻合口难治性狭窄的危险因素。方法 回顾性分析104例食管癌根治术后发生吻合口良性狭窄并经内镜下治疗的患者的临床资料，记录内镜治疗后吻合口狭窄的再发生情况，按内镜下治疗次数分为难治性狭窄组和非难治性狭窄组，采用单因素和多因素Logistic回归模型，分析其危险因素。结果 37例需多次（ > 5次）内镜下治疗的患者，纳入难治性狭窄组，67例 ≤ 5次内镜下治疗的患者，纳入非难治性狭窄组。单因素分析证实其危险因素包括：吻合口位置、吻合器种类、术中出血量、手术时间、术后吻合口瘘、食管癌术后狭窄出现时间、术后是否追加放疗、内镜下扩张后开始进食时间、内镜下治疗方式和内镜下扩张后吻合口直径（P < 0.05）。进一步行多因素Logistic回归分析证实：高位吻合、术后吻合口瘘、术后追加放疗、内镜下单纯扩张和内镜下扩张后吻合口直径 < 13 mm，是难治性吻合口狭窄的独立危险因素（P < 0.05）。结论 对于食管癌根治术后吻合口狭窄的患者，采用内镜下扩张时，应尽量将吻合口直径扩张至13 mm及以上，并联合局部注射抗狭窄药物，尤其是对于高位吻合、术后追加放疗或术后发生吻合口瘘的患者。

Abstract:

Objective To analyze the risk factors for refractory anastomotic stricture after esophagectomy.Methods Clinical data of 104 patients with benign anastomotic stricture after esophageal cancer operation and endoscopic treatment was retrospectively reviewed. The effect of endoscopic treatment was recorded. According to the sessions of endoscopic dilation, anastomotic stricture patients were divided into refractory stricture group ( > 5 times, n = 37) and non-refractory stricture group (≤ 5 times, n = 67). Univariate and multivariate Logistic regression analyses were used to investigate the potential risk factors for the refractory anastomotic stricture.Results Univariate analysis showed that there were significant differences in anastomotic location, anastomat type, intraoperative hemorrhage, operative time, postoperative anastomotic leakage, interval of stricture after surgery, postoperative radiotherapy, time to feeding after endoscopic treatment, endoscopic treatment and anastomotic diameter after dilation (P < 0.05). Multivariate Logistic regression indicated high anastomosis, postoperative anastomotic leakage, postoperative radiotherapy, simple endoscopic dilation and the anastomotic diameter after endoscopic dilation < 13 mm were the independent influencing factors of refractory anastomotic stricture.Conclusion The anastomotic stricture should be dilated to 13 mm and above in diameter, combined with locoregional anti-stenosis drug injections, especially for patients with anastomotic stenosis located in the upper part of esophagus, postoperative anastomotic leakage and radiotherapy.