西北两所区域性医学中心食管癌患者术后并发症的特点及原因探讨

许峰，程巧莲，杜宁，李翔，肖国栋，刘大鹏 ，孙欣，任宏

（1.山西省临猗县第二人民医院，山西运城，044102；2.西安交通大学第一附属医院肿瘤中心，胸外二科，陕西西安，710061）

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摘要：

目的 评估食管癌根治术后出现的并发症特点及风险因素，分析特定并发症的发生原因。方法 回顾分析西北地区两所医学中心2011 年4月至2015年8月收治的579例接受了根治性手术的食管癌患者病例资料，统计分析相关基础疾病因素及术后状态与术后并发症间的关系。结果 患者术后并发症主要为呼吸系统疾病、心血管系统异常及食管吻合口瘘，分别主要表现为急性呼吸衰竭、肺部感染、房颤、心律失常、食管吻合口愈合不良。术前存在糖尿病、呼吸系统疾病及术前的低血清白蛋白状态分别是特定的食管癌术后并发症的独立危险因素，其中术前诊断患有呼吸系统基础疾病为术后患者发生呼吸系统并发症的独立危险因素，而术前诊断有高血压是心血管系统并发症的独立高危因素。同时通过对结果的回顾性分析发现，患者术后出现呼吸系统或心血管系统并发症，包括肺部感染/肺不张/脓胸、房颤及心率失常，均使食管癌术后患者出现食管吻合口瘘的概率增加，各组通过统计分析差异均具有统计学义（P<0.05）。结论 合并有糖尿病、呼吸系统基础疾病、低白蛋白血症的患者接受食管癌根治术后易发生多种并发症，有更高的风险出现术后吻合口愈合不良，术前呼吸系统基础疾病及高血压状态为食管癌术后呼吸系统或心血管系统并发症的特定危险因素，因此应充分地进行围手术期准备并评估手术风险，早中期患者进行合适的手术治疗更有助于降低食管癌术后并发症出现的风险，降低吻合口愈合不良的概率，在避免心血管系统及呼吸系统术后异常的同时亦有助于术后吻合口的良好愈合。

关键词：食管恶性肿瘤；食管癌根治术；术后并发症；食管吻合口瘘；风险分析

中图分类号：R735.1文献标志码：A文章编号：2096-1413(2017)10-0007-04

Characteristic and causes analysis of postoperative complications in patients receiving radical resection of esophageal cancer in two clinical centers in northwest China

XU Feng, CHENG Qiao-lian, DU Ning, LI Xiang, XIAO Guo-dong, LIU Da-peng, SUN Xin, REN Hong

(1. the Second Hospital of Linyi County, Yuncheng 044102; 2. Cancer Center, the Second Thoracic Surgery Department, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China)

ABSTRACT: Objective To evaluae the feartures and risk factors of patients receiving radical resection of esophageal cancer and help to analyze the reasons related to postoperative complications. Methods The clinical data of 579 cases of patients receiving radical surgery for esophaeal cancer from April 2011 to August 2016 of two medical center in north-west China were collected, and the data of basic chronic diseases together with different postoperative status were retro-spectively analyzed. Results Postoperative complications in patients receiving radical resection of esophageal cancer were respiratory system complications, cardiovascular abnormality and the esophageal anastomotic fistula were statistical-lu analyzed. Patients suffering diabetes, basic respiratory disease and preoperative lower serum albumin were the individ-ual risk factors relating to the postoperative complications, including respiratory system complications of acute respira-tory failure and pulmonary infection, cardiovascular abnormality of atrial fibrillation and arrhythmia, and the esophageal anastomotic fistula (P<0.05). Conclusion Postoperative complications are more likely to happen in patients associating with diabetes, basic respiratory disease or lower serum albumin respectively, respiratory underling disease and hyperten-sion are the key risk factors of postsurgery complication of respiratory or cardiovascular system, sufficient intensive peri-operative care, rigorous operative risk assessments, and selection of the patients of esophageal cancer in early and medi-um stage will all help to decrease the risks of postoperative complications in patients receiving radical resection of esophageal cancer.

KEYWORDS: malignant esophageal tumor; radical operation for esophageal cancer; postoperative complications; anasto-motic fistula; risk analysis.

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