评价纤维蛋白胶在预防 McKeown 食管癌根治术后吻合口瘘中的作用：一项单中心回顾性研究。

Evaluation of Fibrin Sealant in Prevention of Cervical Anastomotic Leakage After McKeown Esophagectomy: A Single-Center, Retrospective Study.

机构信息

Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.

Department of Ultrasound and Electrocardiogram, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China.

出版信息

Ann Surg Oncol. 2021 Oct;28(11):6390-6397. doi: 10.1245/s10434-021-09877-0. Epub 2021 Mar 30.

DOI:10.1245/s10434-021-09877-0

PMID:33786677

Abstract

BACKGROUND

Anastomotic leakage remains an issue after esophagectomy for patients with esophageal or esophagogastric junction cancer. Previous studies have indicated that the intraoperative application of fibrin sealant may reduce the incidence of postoperative anastomotic leakage. This retrospective study was aimed to evaluate the efficacy and safety of fibrin sealant in the prevention of anastomotic leakage in patients undergoing McKeown esophagectomy.

METHODS

We designed a single-center, retrospective study. Between January 2018 and December 2019, 227 patients with esophageal or esophagogastric junction cancer undergoing McKeown esophagectomy performed by our team were retrospectively identified, of whom 86 patients were included in the FS group and 141 patients were included in the control group. Intraoperatively, 2.5 ml of porcine fibrin sealant was applied circumferentially to the cervical anastomosis after the anastomosis was created in the FS group. The primary outcome was the incidence of cervical anastomotic leakage within the first three months after surgery.

RESULTS

The differences in baseline clinical characteristics between the two groups were not significant except for a history of drinking. In the FS group, the postoperative cervical anastomotic leakage rate was lower (FS group: 4.7% [4 of 82] vs. control group: 19.9% [28 of 141], p < 0.01). Multivariate logistic regression showed that the intraoperative application of fibrin sealant was an independent protective factor for anastomotic leakage (OR 0.169, 95% CI 0.055-0.515, p = 0.002).

CONCLUSIONS

The intraoperative application of fibrin sealant could possibly prevent cervical anastomotic leakage after McKeown esophagectomy with satisfactory safety. Further prospective clinical trials are warranted.

摘要

背景

食管癌或食管胃交界癌患者行食管切除术术后吻合口漏仍然是一个问题。先前的研究表明，术中应用纤维蛋白密封剂可能会降低术后吻合口漏的发生率。本回顾性研究旨在评估纤维蛋白密封剂在预防 McKeown 食管切除术后吻合口漏中的疗效和安全性。

方法

我们设计了一项单中心回顾性研究。2018 年 1 月至 2019 年 12 月，我们团队对 227 例接受 McKeown 食管切除术的食管癌或食管胃交界癌患者进行了回顾性分析，其中 86 例患者纳入 FS 组，141 例患者纳入对照组。在 FS 组，吻合完成后，在颈部吻合口周围应用 2.5ml 猪纤维蛋白密封剂。主要结局是术后 3 个月内发生颈部吻合口漏的发生率。

结果

两组患者的基线临床特征差异无统计学意义，除饮酒史外。FS 组术后颈部吻合口漏发生率较低（FS 组：4.7%[4/82] vs. 对照组：19.9%[28/141]，p<0.01）。多因素 logistic 回归显示，术中应用纤维蛋白密封剂是吻合口漏的独立保护因素（OR 0.169，95%CI 0.055-0.515，p=0.002）。