经胸与经腹食管切除术：945例患者的前瞻性研究

Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients.

作者信息

Rentz Jeffrey, Bull David, Harpole David, Bailey Stephen, Neumayer Leigh, Pappas Theodore, Krasnicka Barbara, Henderson William, Daley Jennifer, Khuri Shukri

机构信息

Veterans Affairs Medical Center/University of Utah Medical School, Salt Lake City, Utah 84132-2301, USA.

出版信息

J Thorac Cardiovasc Surg. 2003 May;125(5):1114-20. doi: 10.1067/mtc.2003.315.

DOI:10.1067/mtc.2003.315

PMID:12771885

Abstract

OBJECTIVE

Debate continues as to whether transhiatal esophagectomy results in lower morbidity and mortality than transthoracic esophagectomy. Most data addressing this issue are derived from single-institution studies. To investigate this question from a nationwide multicenter perspective, we used the Veterans Administration National Surgical Quality Improvement Program to prospectively analyze risk factors for morbidity and mortality in patients undergoing transthoracic esophagectomy or transhiatal esophagectomy from 1991 to 2000.

METHODS

Univariate and multivariate analyses were performed on 945 patients (mean age, 63 +/- 10 years). There were 562 transthoracic esophagectomies and 383 transhiatal esophagectomies in 105 hospitals, with complete 30-day outcomes recorded.

RESULTS

There were no differences in recorded preoperative variables between the groups that might bias any comparisons. Overall mortality was 10.0% (56/562) for transthoracic esophagectomy and 9.9% (38/383) for transhiatal esophagectomy (P =.983). Morbidity occurred in 47% (266/562) of patients after transthoracic esophagectomy and in 49% (188/383) of patients after transhiatal esophagectomy (P =.596). Risk factors for mortality common to both groups included a serum albumin value of less than 3.5 g/dL, age greater than 65 years, and blood transfusion of greater than 4 units (P <.05). When comparing transthoracic esophagectomy with transhiatal esophagectomy, there was no difference in the incidence of respiratory failure, renal failure, bleeding, infection, sepsis, anastomotic complications, or mediastinitis. Wound dehiscence occurred in 5% (18/383) of patients undergoing transhiatal esophagectomy and only 2% (12/562) of patients undergoing transthoracic esophagectomy (P =.036).

CONCLUSIONS

These data demonstrate no significant differences in preoperative variables and postoperative mortality or morbidity between transthoracic esophagectomy and transhiatal esophagectomy on the basis of a 10-year, prospective, multi-institutional, nationwide study.

摘要

目的

关于经裂孔食管切除术与经胸食管切除术相比是否能降低发病率和死亡率的争论仍在继续。解决这个问题的大多数数据来自单机构研究。为了从全国多中心的角度研究这个问题，我们利用退伍军人事务部国家外科质量改进计划，对1991年至2000年接受经胸食管切除术或经裂孔食管切除术的患者的发病和死亡风险因素进行了前瞻性分析。

方法

对945例患者（平均年龄63±10岁）进行单因素和多因素分析。105家医院共进行了562例经胸食管切除术和383例经裂孔食管切除术，并记录了完整的30天结果。

结果

两组术前记录的变量无差异，不会影响任何比较。经胸食管切除术的总死亡率为(10.0%)（56/562），经裂孔食管切除术的总死亡率为(9.9%)（38/383）（P = 0.983）。经胸食管切除术后(47%)（266/562）的患者发生并发症，经裂孔食管切除术后(49%)（188/383）的患者发生并发症（P = 0.596）。两组共有的死亡风险因素包括血清白蛋白值低于3.5 g/dL、年龄大于65岁和输血超过4单位（P < 0.05）。比较经胸食管切除术和经裂孔食管切除术时，呼吸衰竭、肾衰竭、出血、感染、败血症、吻合口并发症或纵隔炎的发生率无差异。经裂孔食管切除术患者的伤口裂开发生率为(5%)（18/383），经胸食管切除术患者的伤口裂开发生率仅为(2%)（12/562）（P = 0.036）。