Tracheobronchial Lesions Following Esophagectomy: Erosions, Ulcers, and Fistulae, and the Predictive Value of Lymph Node-Related Factors
Tracheobronchial Lesions Following Esophagectomy: Erosions, Ulcers, and Fistulae, and the Predictive Value of Lymph Node-Related Factors
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DOI：
10.1007/s00268-008-9871-7
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发表时间：
2009-04-01
影响因子：
2.6
通讯作者：
Ogawa, Jun-ichi
中科院分区：
文献类型：
--
作者：
Maruyama, Kiyotomi;Motoyama, Satoru;Ogawa, Jun-ichi
食道切除后，气管、支气管部周围广泛剥离引起的缺血可导致气管、支气管部病变(TBL)。在这项研究中，我们评估了这些并发症的原因和临床特征，特别关注了与淋巴结(LN)相关的因素。从2000年1月到2007年3月，连续305例患者接受了经胸入路食管次全切除术，并进行了LN清扫。术后每天两次进行支气管镜检查，发现包括侵蚀、溃疡和瘘管在内的TBL，术中无创伤性损伤。本组病例共14例，发生率为5%，其中6例为瘘管，5例为溃疡，3例为糜烂。有三野LN夹层(3FLD)的病例明显多于无三野LN夹层的病例。6例(43%)有4个以上的淋巴结转移，9例(%)有颈部和上纵隔淋巴结转移(p=0.034和0.041)。10例(71%)患者有60个以上的淋巴结被清扫(p=0.021)，Logistic回归分析显示60个以上的淋巴结清扫和3FLD是TBL的独立预测因素。食道癌患者需要广泛清扫60个以上的淋巴结和/或3FLD的患者在术后病程中发生TBL的风险增加。
Following esophagectomy, tracheobronchial lesions (TBLs) can occur as a result of ischemia caused by extensive dissection around the tracheobronchus. In this study we assessed the causes and clinical features of these complications, paying particular attention to lymph node (LN)-related factors.Between January 2000 and March 2007, 305 consecutive patients underwent subtotal esophagectomy using a transthoracic approach with LN dissection for thoracic esophageal cancer. TBLs, including erosions, ulcers, and fistulae, without traumatic injury during the operation, were detected during bronchoscopic examinations performed twice daily after the operation. The correlation between TBLs and tumor or surgical factors were analyzed.TBLs were observed in 14 patients, accounting for an overall incidence of 5%; these included 6 fistulae, 5 ulcers, and 3 erosions. Cases with TBLs significantly more often involved three-field LN dissections (3FLD) than those without TBLs. Six (43%) patients with TBLs had more than four metastatic lymph nodes, while 9 (64%) had cervical and upper-mediastinal LN metastasis (p = 0.034 and 0.041, respectively). More than 60 LNs were dissected from 10 (71%) patients with TBLs (p = 0.021), and logistic regression analysis revealed that dissection of more than 60 lymph nodes and 3FLD were independent predictors of TBLs.Esophageal cancer patients requiring extensive LN dissection of more than 60 nodes and/or 3FLD have an increased risk of developing a TBL during their postoperative course.