Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara 634-8522, Japan.
J Gastrointest Surg. 2012 Sep;16(9):1659-65. doi: 10.1007/s11605-012-1932-4. Epub 2012 Jun 12.
The aim of this study was to investigate the correlation between intraoperative anastomotic troubles and the incidence of esophagojejunal anastomotic leakage (EJAL), and to identify risk factors for EJAL after elective gastrectomy for gastric cancer.
This study reviewed the medical and surgical records of 327 patients who underwent elective gastrectomy followed by esophagojejunostomy. A multivariate analysis was performed to determine the risk factors for EJAL.
An EJAL occurred in 19 patients (5.8 %). A multivariate analysis demonstrated that hemoglobin A1c ≥7.0 % (p < 0.01), chronic renal failure (p < 0.01), proximal gastrectomy (p < 0.05), and anastomotic trouble during construction of the esophagojejunostomy (p < 0.01) were independent predictors for EJAL. Anastomotic trouble during construction of esophagojejunostomy occurred in 20 patients (6.1 %), and EJAL occurred in 6 of these 20 patients (30 %). Four of ten patients (40 %) in whom an incomplete anastomosis was repaired by suturing during surgery had an EJAL, while none of seven patients who underwent re-anastomosis had this complication.
EJAL is strongly associated with intraoperative technical errors. To reduce this complication, proper anastomotic techniques are required. Re-anastomosis should be performed when an incomplete anastomosis is discovered during surgery.
本研究旨在探讨术中吻合口并发症与食管空肠吻合口瘘（EJAL）发生率之间的相关性，并确定择期胃癌根治术后 EJAL 的危险因素。
本研究回顾性分析了 327 例行择期胃切除术加食管空肠吻合术的患者的病历和手术记录。采用多因素分析确定 EJAL 的危险因素。
19 例（5.8%）发生 EJAL。多因素分析显示，血红蛋白 A1c≥7.0%（p<0.01）、慢性肾衰竭（p<0.01）、近端胃切除术（p<0.05）和食管空肠吻合术时吻合口并发症（p<0.01）是 EJAL 的独立预测因素。20 例（6.1%）患者在食管空肠吻合术时发生吻合口并发症，其中 6 例（30%）发生 EJAL。10 例术中采用缝合修复不完全吻合口的患者中有 4 例（40%）发生 EJAL，而 7 例再次吻合的患者均未发生该并发症。
EJAL 与术中技术失误密切相关。为减少这种并发症，需要采用适当的吻合技术。如果术中发现不完全吻合，应进行再吻合。
