Çetin Durmuş Ali, Gündeş Ebubekir, Çiyiltepe Hüseyin, Aday Ulaş, Uzun Orhan, Cumhur Değer Kamuran, Duman Mustafa
Şanlıurfa Eğitim ve Araştırma Hastanesi, Gastroenteroloji Cerrahi Kliniği, Şanlıurfa, Türkiye.
Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Gastroentereloji Cerrahi Kliniği, Diyarbakır, Türkiye.
Turk J Surg. 2018 Nov 20;35(1):6-12. doi: 10.5578/turkjsurg.4117. eCollection 2019 Mar.
Esophagojejunal anastomotic leakages, which occur in the reconstruction procedures performed after total or proximal gastrectomy, still account for one of the most significant causes of morbidity and mortality in spite of the developments seen in perioperative management and surgical techniques in gastric cancer surgery. The aim of the present study was to ascertain the risk factors for Esophagojejunal anastomotic leakages.
A total of 80 patients with gastric cancer, who had total gastrectomy +D2 lymph node dissection and Esophagojejunal anastomotic between January 2013 and December 2016, were retrospectively evaluated. Patients who did not have anastomotic leakages during their clinical follow-ups were allocated to Group 1, whereas those who had anastomotic leakages were allocated to Group 2.
A total of 58 (72.5%) out of 80 patients were males, whereas 22 (27.5%) were females. Mean age of the patients was 61.2 ± 11.2 years. There were no demographic differences between the groups. Postoperative recurrent fever (p= 0.001), C-reactive protein values on postoperative days 3 and 5 (p= 0.01), and neutrophil-to-lymphocyte ratio on postoperative day 5 (p= 0.022) were found to be statistically significant with regard to Esophagojejunal anastomotic leakages and other postoperative complications. The duration of operation (p= 0.032) and combined organ resection (p= 0.008) were ascertained as risk factors for Esophagojejunal anastomotic leakages.
Surgeons should be careful about Esophagojejunal anastomotic leakages which are significant postoperative complications seen especially in cases where the duration of operation is prolonged, and additional organ resections are performed. Recurrent fever, high C-reactive protein levels, and neutrophil-to-lymphocyte ratio may serve as warnings for complications in postoperative follow-ups.
尽管胃癌手术的围手术期管理和手术技术有所发展，但在全胃或近端胃切除术后的重建手术中发生的食管空肠吻合口漏，仍然是发病和死亡的最重要原因之一。本研究的目的是确定食管空肠吻合口漏的危险因素。
回顾性评估了2013年1月至2016年12月期间共80例行全胃切除术+D2淋巴结清扫及食管空肠吻合术的胃癌患者。临床随访期间未发生吻合口漏的患者被分配到第1组，而发生吻合口漏的患者被分配到第2组。
80例患者中，58例（72.5%）为男性，22例（27.5%）为女性。患者的平均年龄为61.2±11.2岁。两组之间在人口统计学上无差异。发现术后反复发热（p=0.001）、术后第3天和第5天的C反应蛋白值（p=0.01）以及术后第5天的中性粒细胞与淋巴细胞比值（p=0.022）在食管空肠吻合口漏及其他术后并发症方面具有统计学意义。手术时间（p=0.032）和联合器官切除（p=0.008）被确定为食管空肠吻合口漏的危险因素。
外科医生应注意食管空肠吻合口漏，这是一种重要的术后并发症，尤其在手术时间延长和进行额外器官切除的情况下。反复发热、高C反应蛋白水平和中性粒细胞与淋巴细胞比值可能在术后随访中作为并发症的警示信号。
