Ding Ningning, Mao Yousheng, He Jie, Gao Shugeng, Zhao Yue, Yang Ding, Sun Kelin, Cheng Guiyu, Mu Juwei, Xue Qi, Wang Dali, Zhao Jun, Gao Yushun, Liu Xiangyang, Fang Dekang, Li Jian, Wang Yonggang, Huang Jinfeng, Wang Bing, Zhang Liangze
Department of Thoracic Surgery, Cancer Hospital (Institute), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
J Thorac Dis. 2017 Feb;9(2):386-391. doi: 10.21037/jtd.2017.02.34.
It was reported in the literatures that the incidence of anastomotic leakage in patients with esophagogastric junction cancer decreased due to application of staplers and closure devices as well as gastric conduit technique in recent years, however, it increased slightly at our center since widely using the above devices and gastric conduit techniques from 2009. The objective of this study was to summarize our experiences in the management of anastomotic leakages and analyze the factors affecting leakage healing in the patients with esophagogastric junction cancer after surgical resection in recent 6 years.
All patients who received surgical resections for esophagogastric junction cancer and diagnosed anastomotic leak at our center between January 2009 and December 2014 were retrospectively analyzed, we also enrolled the patients who had a longer hospital stay (>30 days) as they may develop anastomotic leak. The binary logistic regression in SPSS 16.0 was applied to analyze the factors that may affect leakage healing.
Of the 1,815 surgically treated esophagogastric junction cancer patients, 91 cases were diagnosed anastomotic leakage postoperatively. The patients were divided into two groups based on the median leakage healing time (40 days) in this series: fast healing group (37 cases) and slowly healing group (54 cases). All factors that may affect the leakage healing were put into analysis by using binary logistic regression. The results of the analysis showed that leakage size (OR =1.073, P=0.004), thoracic drainage (OR =12.937, P=0.037) and smoking index ≤400 (OR =1.001, P=0.04) significantly affected the healing time, while drinking history (P=0.177), duration of fever after anastomotic leak developed (P=0.084), and hypoproteinemia after leak (P=0.169) also apparently but not significantly affect the healing time.
Though many factors may affect leakage healing in the esophagogastric junction carcinoma patients, leakage size, thoracic drainage and smoking index (≤400) are the most important factors affecting the leakage healing. Placement of a chest tube beside the anastomosis area during operation for early identification and control of an anastomotic leak to minimize contamination of the mediastinum is the most important way to promote leakage healing. A chest tube placing into the purulent cavities after the patients experienced leaks is also important for the cure of leakage. More attention should be paid perioperatively to the patients who had a smoking index (≥400) and the patients who suffered fever or hypoproteinemia.
文献报道，近年来由于吻合器、闭合器的应用以及胃代食管技术的开展，食管胃交界部癌患者吻合口漏的发生率有所下降，但自2009年我院广泛应用上述器械及胃代食管技术以来，吻合口漏的发生率却略有上升。本研究旨在总结我院近6年食管胃交界部癌手术切除后吻合口漏的处理经验，并分析影响漏口愈合的因素。
回顾性分析2009年1月至2014年12月在我院接受食管胃交界部癌手术切除且术后诊断为吻合口漏的患者，同时纳入住院时间较长（>30天）可能发生吻合口漏的患者。应用SPSS 16.0软件进行二元logistic回归分析可能影响漏口愈合的因素。
1815例接受手术治疗的食管胃交界部癌患者中，91例术后诊断为吻合口漏。根据本系列患者漏口愈合时间中位数（40天）将患者分为两组：愈合快组（37例）和愈合慢组（54例）。将所有可能影响漏口愈合的因素纳入二元logistic回归分析。分析结果显示，漏口大小（OR =1.073，P=0.004）、胸腔引流（OR =12.937，P=0.037）和吸烟指数≤400（OR =1.001，P=0.04）显著影响愈合时间，而饮酒史（P=0.177）、吻合口漏发生后发热持续时间（P=0.084）和漏口发生后低蛋白血症（P=0.169）虽对愈合时间有明显影响但不显著。
尽管多种因素可能影响食管胃交界部癌患者漏口的愈合，但漏口大小、胸腔引流和吸烟指数（≤400）是影响漏口愈合的最重要因素。术中在吻合口旁放置胸管以便早期发现和控制吻合口漏，减少纵隔污染，是促进漏口愈合的最重要方法。患者发生漏口后将胸管置入脓腔对漏口的治愈也很重要。围手术期应更多关注吸烟指数（≥400）以及发热或低蛋白血症的患者。
