Reducing hospital morbidity and mortality following esophagectomy
Reducing hospital morbidity and mortality following esophagectomy
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DOI：
10.1016/j.athoracsur.2004.02.034
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发表时间：
2004-10-01
影响因子：
4.6
通讯作者：
D'Amico, TA
中科院分区：
文献类型：
--
作者：
Atkins, BZ;Shah, AS;D'Amico, TA
背景资料。食道胃切除术(EG)是一种发病率和死亡率都很高的手术。已经进行了风险因素分析，但很少有研究提出改善手术结果的策略。这项研究是为了确定预后变量，这些变量可能被用来制定优化EG术后结果的策略。对1996年至2002年间在三级医学中心接受EG治疗的379名患者的记录进行了回顾。测定30天的发病率和死亡率，多变量Logistic回归分析评估术前和术后变量对早期死亡率的影响。手术方式包括依弗-刘易斯(n=179)、经颅(n=130)和其他入路(n=70)。手术死亡率为5.8%；有并发症，包括呼吸道并发症(28.5%)、吻合口狭窄(25%)和渗漏(14%)。单因素分析显示，年龄增加、吻合口漏、Charlson合并症指数3、吞咽评分更差和肺炎与死亡风险增加相关。然而，多变量分析显示，只有年龄(p=0.002)和肺炎(p=0.0008)与死亡率独立相关。肺炎与20%的死亡率有关。肺炎患者的吞咽和吻合口完整性明显低于非肺炎患者(P<；0.001，Mann-Whitney秩和检验)。EG的发病率和死亡率很重要，但大多数并发症，包括吻合口漏，并不是死亡率的独立预测因素。EG后最重要的并发症是肺炎。降低术后死亡率的策略应该包括仔细评估吞咽异常和通过放射成像术或纤维内窥镜检查是否易误吸。EG后，在恢复口服之前，应验证可接受的咽部功能和呼吸道保护。(C)2004年，由胸外科医生学会提供。
Background. Esophagogastrectomy (EG) is a formidable operation with significant morbidity and mortality rates. Risk factor analyses have been performed, but few studies have produced strategies that have improved operative results. This study was performed in order to identify prognostic variables that might be used to develop a strategy for optimizing outcomes after EG.Methods. The records of all patients (n = 379) who underwent EG patients at a tertiary medical center between 1996 and 2002 were retrospectively reviewed. Thirty-day morbidity and mortality were determined, and multivariable logistical regression analysis assessed the effect of preoperative and postoperative variables on early mortality.Results. Operations included Ivor Lewis (n = 179), transhiatal (n = 130), and other approaches (n = 70). Operative mortality was 5.8%; 64% experienced complications, including respiratory complications (28.5%), anastamotic strictures (25%), and leak (14%). Increasing age, anastomotic leak, Charlson comorbidity index 3, worse swallowing scores, and pneumonia were associated with increased risk of mortality by univariate analysis. However, only age (p = 0.002) and pneumonia (p = 0.0008) were independently associated with mortality by multivariable analysis. Pneumonia was associated with a 20% incidence of death. Patients with pneumonia had significantly worse deglutition and anastomotic integrity on barium esophagogram compared with patients without pneumonia (p < 0.001, Mann-Whitney rank sum test).Conclusions. Morbidity and mortality of EG are significant, but most complications, including anastomotic leak, are not independent predictors of mortality. The most important complication after EG is pneumonia. Strategies to decrease postoperative mortality should include careful assessment of swallowing abnormalities and predisposition to aspiration by cineradiography or fiberoptic endoscopy. After EG, acceptable pharyngeal function and airway protection should be verified before resuming oral intake. (C) 2004 by The Society of Thoracic Surgeons.