Li Z H, Ding W L, Lyu K L, Sun B K, Dong K Q, Wang M B, Su P, Tian Z Z
Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
Zhonghua Wai Ke Za Zhi. 2025 Feb 1;63(2):130-135. doi: 10.3760/cma.j.cn112139-20240805-00364.
To explore the related risk factors of diaphragmatic hernia after thoraco-laparoscopic minimally invasive Mckeown esophagectomy (MIME). This is a retrospective controlled study. A retrospective analysis was conducted on the clinical data of patients who underwent MIME at the Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, from January 2016 to December 2023. A total of 619 patients were included. There were 423 males and 196 females, aged (63.7±7.6) years (range: 37 to 87 years). The diagnosis of diaphragmatic hernia after MIME was made based on clinical symptoms and CT scans. Patients were divided into two groups: the diaphragmatic hernia group (=16) and the non-diaphragmatic hernia group (=603). Clinical data, including age, gender, body mass index (BMI), smoking history, tumor location (upper, middle, and lower thoracic esophagus), preoperative neoadjuvant therapy history, and tumor staging, were collected and analyzed. A BMI of 25 kg/m² and age of 65 years were used as cutoff values. The ² test and Fisher's exact test were used to compare the data between the two groups, and Logistic regression was employed for risk factor analysis. The diaphragmatic hernia group and non-diaphragmatic hernia group were matched in a 1∶3 ratio with a caliper value of 0.02 by propensity score matching. Kaplan-Meier method was used for survival analysis and compared using the log-rank test for between-group differences. The proportion of patients with diaphragmatic hernia after MIME who underwent surgical treatment was 6/16. Statistically significant differences were observed between the diaphragmatic hernia group and the non-diaphragmatic hernia group in terms of age (²=16.057, <0.01), BMI (²=16.057, <0.01), and tumor location (²=12.048, =0.002). Multivariate logistic regression analysis revealed that age ≥65 years (=1.236, =0.023) and BMI<25 kg/m² (=0.810, <0.01) were independent risk factors for the development of diaphragmatic hernia after MIME. Survival analysis showed no significant difference in long-term survival between patients with and without diaphragmatic hernia after MIME (=0.187), and whether patients with diaphragmatic hernia underwent surgery was not associated with long-term prognosis (=0.560). Patients with BMI<25 kg/m and age ≥65 years are independent risk factors for diaphragmatic hernia after MIME. The occurrence of diaphragmatic hernia is not associated with prognosis, and whether patients with diaphragmatic hernia undergo surgery does not affect the prognosis.
探讨胸腹腔镜微创麦克尤恩食管切除术（MIME）后膈疝的相关危险因素。这是一项回顾性对照研究。对2016年1月至2023年12月在河北医科大学第四医院胸外科接受MIME的患者的临床资料进行回顾性分析。共纳入619例患者。其中男性423例，女性196例，年龄（63.7±7.6）岁（范围：37至87岁）。MIME后膈疝的诊断基于临床症状和CT扫描。患者分为两组：膈疝组（n = 16）和非膈疝组（n = 603）。收集并分析包括年龄、性别、体重指数（BMI）、吸烟史、肿瘤位置（胸段食管上、中、下段）、术前新辅助治疗史和肿瘤分期等临床资料。将BMI 25 kg/m²和年龄65岁作为截断值。采用χ²检验和Fisher精确检验比较两组数据，并采用Logistic回归进行危险因素分析。通过倾向得分匹配以1∶3的比例、卡尺值0.02对膈疝组和非膈疝组进行匹配。采用Kaplan-Meier法进行生存分析，并使用对数秩检验比较组间差异。MIME后发生膈疝且接受手术治疗的患者比例为6/16。膈疝组和非膈疝组在年龄（χ² = 16.057，P < 0.01）、BMI（χ² = 16.057，P < 0.01）和肿瘤位置（χ² = 12.048，P = 0.002）方面存在统计学显著差异。多因素Logistic回归分析显示，年龄≥65岁（OR = 1.236，P = 0.023）和BMI < 25 kg/m²（OR = 0.810，P < 0.01）是MIME后发生膈疝的独立危险因素。生存分析显示，MIME后有膈疝和无膈疝患者的长期生存无显著差异（P = 0.187），膈疝患者是否接受手术与长期预后无关（P = 0.560）。BMI < 25 kg/m且年龄≥65岁的患者是MIME后膈疝的独立危险因素。膈疝的发生与预后无关，膈疝患者是否接受手术不影响预后。
