Hikasa Yukiko, Suzuki Satoshi, Mihara Yuko, Tanabe Shunsuke, Shirakawa Yasuhiro, Fujiwara Toshiyoshi, Morimatsu Hiroshi
Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
Department of Gastroenterological Surgery Transplant and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
J Anesth. 2020 Jun;34(3):404-412. doi: 10.1007/s00540-020-02766-y. Epub 2020 Mar 30.
Compared with open thoracotomy, minimally invasive esophagectomy (MIE) methods, such as transhiatal or thoracoscopic esophagectomy, likely have lower morbidity. However, the relationship between intraoperative fluid management and postoperative complications after MIE remains unclear. Thus, we investigated the association of cumulative intraoperative fluid balance and postoperative complications in patients undergoing MIE.
This single-center retrospective cohort study examined patients undergoing thoracoscopic esophagectomy for esophageal cancer in the prone position. Postoperative complications included pneumonia, arrhythmia, thrombotic events and acute kidney injury (AKI). We compared patients with higher and lower intraoperative fluid balance (higher and lower than the median). Multivariable logistic regression analyses were performed to estimate the odds ratio of intraoperative fluid balance status on the incidence of postoperative complications.
In total, 135 patients were included in the study. Postoperative complications occurred in 43 (32%), including cardiac arrhythmia (n = 12, 9%), thrombosis (n = 20, 15%), pneumonia (n = 13, 10%), and AKI required hemodialysis (n = 1, 1%). Patients with a higher fluid balance had higher incidence of complications than those with a lower fluid balance (46% vs. 18%, p < 0.001). After adjusting for age, ASA-PS ≥ III, blood loss, and the use of radical surgery, the higher intraoperative fluid balance group was significantly and independently associated with postoperative complications (adjusted OR 5.31, 95% CI 2.26-13.6, p < 0.0001).
In patients undergoing thoracoscopic esophagectomy in the prone position, a greater intraoperative positive fluid balance was independently associated with a higher incidence of complications.
与开胸手术相比，微创食管切除术（MIE）方法，如经裂孔或胸腔镜食管切除术，可能发病率更低。然而，MIE术中液体管理与术后并发症之间的关系仍不明确。因此，我们研究了接受MIE患者术中累积液体平衡与术后并发症之间的关联。
这项单中心回顾性队列研究检查了在俯卧位接受胸腔镜食管癌切除术的患者。术后并发症包括肺炎、心律失常、血栓形成事件和急性肾损伤（AKI）。我们比较了术中液体平衡较高和较低（高于和低于中位数）的患者。进行多变量逻辑回归分析以估计术中液体平衡状态对术后并发症发生率的比值比。
该研究共纳入135例患者。43例（32%）发生术后并发症，包括心律失常（n = 12，9%）、血栓形成（n = 20，15%）、肺炎（n = 13，10%）和需要血液透析的AKI（n = 1，1%）。液体平衡较高的患者并发症发生率高于液体平衡较低的患者（46%对18%，p < 0.001）。在调整年龄、美国麻醉医师协会身体状况评分（ASA-PS）≥III、失血和根治性手术的使用后，术中液体平衡较高组与术后并发症显著且独立相关（调整后的比值比为5.31，95%置信区间为2.26-13.6，p < 0.0001）。
在俯卧位接受胸腔镜食管切除术的患者中，术中更大的正液体平衡与更高的并发症发生率独立相关。
