食管癌切除术后吻合口漏的危险因素：胸段硬膜外镇痛的影响。

Risk factors for anastomotic leakage following esophagectomy: Impact of thoracic epidural analgesia.

作者信息

Wang Wen, Zhao Gefei, Wu Linxin, Dong Yanpeng, Zhang Chaobin, Sun Li

机构信息

Department of Anesthesiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

J Surg Oncol. 2017 Aug;116(2):164-171. doi: 10.1002/jso.24621. Epub 2017 Apr 6.

DOI:10.1002/jso.24621

PMID:28384375

Abstract

BACKGROUND AND OBJECTIVES

Anastomotic leakage (AL) is one of common complications after esophageal cancer surgery. Thoracic epidural analgesia (TEA) is often recommended in patients undergoing esophagectomy. However, the impact of TEA on AL is still controversial. Thus, we conducted this study to evaluate the effect of TEA on the occurrence of AL and identify risk factors for the development of AL following esophagectomy.

METHODS

Our retrospective study identified patients who underwent elective esophagectomy between July 2013 and July 2016. Univariate and multivariate logistics analyses and propensity score matching analysis were conducted to identify the risk factors for AL occurring within 30 days after operation.

RESULTS

Overall 30-day AL was 7.9%. Multivariate analysis revealed that surgical procedure (Sweet: referent; Ivor-Lewis: OR 2.854; 95%CI 1.726-4.718; Three-incision: OR 4.837; 95%CI 3.457-6.768) and surgeon (high-volume: referent; low-volume: OR 1.740; 95%CI 1.269-2.384) were independent risk factors for AL after esophagectomy. No statistically significant difference was observed in the incidences of AL between the epidural analgesia group and the intravenous analgesia group either before or after propensity score matching (9.1% vs 7.7%, P = 0.359; 8.3% vs 9.2%, P = 0.683).

CONCLUSIONS

TEA does not affect the AL risk after esophagectomy.

摘要

背景与目的

吻合口漏（AL）是食管癌手术后常见的并发症之一。胸段硬膜外镇痛（TEA）常用于接受食管切除术的患者。然而，TEA对AL的影响仍存在争议。因此，我们开展本研究以评估TEA对AL发生的影响，并确定食管切除术后AL发生的危险因素。

方法

我们的回顾性研究纳入了2013年7月至2016年7月期间接受择期食管切除术的患者。进行单因素和多因素逻辑分析以及倾向评分匹配分析，以确定术后30天内发生AL的危险因素。

结果

总体30天AL发生率为7.9%。多因素分析显示，手术方式（Sweet术式：参照；Ivor-Lewis术式：OR 2.854；95%CI 1.726 - 4.718；三切口术式：OR 4.837；95%CI 3.457 - 6.768）和外科医生（高手术量：参照；低手术量：OR 1.740；95%CI 1.269 - 2.384）是食管切除术后AL的独立危险因素。倾向评分匹配前后，硬膜外镇痛组和静脉镇痛组的AL发生率均无统计学显著差异（9.1%对7.7%，P = 0.359；8.3%对9.2%，P = （此处原文有误，应为0.683））。