Perioperative risk factors for anastomotic leakage after esophagectomy
Perioperative risk factors for anastomotic leakage after esophagectomy
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DOI：
10.1378/chest.128.5.3461
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发表时间：
2005-11-01
期刊：
影响因子：
9.6
通讯作者：
Auffray, JP
中科院分区：
文献类型：
--
作者：
Michelet, P;D'Journo, XB;Auffray, JP
研究目的：食管切除术后吻合口漏与术后高发病率和死亡率相关。吻合口漏最重要的诱发因素是胃导管缺血和低血氧含量。本研究的目的是评估胸段硬膜外镇痛（TEA）对食管切除术后吻合口瘘发生率的影响。设计：回顾性研究。设置：教学医院胸外科和麻醉科。患者：1998年至2003年期间接受一期食管切除术的207例患者。干预措施：分析围手术期因素及术后并发症对吻合口瘘发生率的影响。渗漏定义为通过离子X线造影研究检测到的吻合口破裂，并在术后期间通过上消化道内窥镜检查证实。分析的因素包括有效的TEA放置在外科手术proceeding. Measures和结果：吻合口漏发生在23例（11%）。该并发症与ICU和住院时间显著增加相关（平均值分别为19 +/- 16天vs 9 +/- 7天[+/- SD]，p = 0.008; 43 +/- 27天vs 23 +/- 11天; p < 0.001）。吻合口瘘患者的死亡率为26%，而其余患者为5.4%（p = 0.002）。与渗漏发生率独立相关的因素包括手术过程中估计的每毫升失血量（比值比[OR]，1.004; 95%置信区间[CI]，1.001 - 1.007），吻合的颈部位置（OR，5.4; 95%CI，1.3 - 22.9），以及术后发生ARDS（OR，4.1; 95%CI，2.6 - 176.5）。93例患者从有效TEA中获益4.4 +/- 0.8天。TEA的使用与吻合口漏发生率的降低独立相关（OR，0.13; 95%CI，0.02至0.71）。结论：本回顾性研究的结果表明，TEA与吻合口漏发生率的降低相关。
Study objectives: Anastoniotic leakage after esophagectomy is associated with high postoperative morbidity and mortality. The most important predisposing factors for anastomotic leaks are ischemia of the gastric conduit and low blood oxygen content. The aim of this study was to evaluate the influence of thoracic epidural analgesia (TEA) on the incidence of anastomotic leakage after esophagectomy.Design: Retrospective study.Setting: A thoracic surgery and anesthesia department in a teaching hospital.Patients: Two hundred seven patients who underwent one-stage esophagectomy between 1998 and 2003.Interventions: The effects of perioperative factors and postoperative complications on the incidence of anastomotic leakage were analyzed. Leakage was defined as an anastomotic disruption detected by, an ionic x-ray contrast study and confirmed by upper endoscopy in the postoperative period. Analyzed factors included effective TEA placed before the surgical procedure.Measurements and results: Anastomotic leakage occurred in 23 patients (11%). This complication was associated with a significant increase in length of stay in the ICU and in the hospital (mean, 19 +/- 16 days vs 9 +/- 7 days [+/- SD], p = 0.008; and 43 +/- 27 days vs 23 +/- 11 days, respectively; p < 0.001). Mortality in patients presenting anastomotic leakage was 26%, compared with 5.4% in the remainder (p = 0.002). Factors independently associated with the incidence of leakage included estimated blood loss per milliliter during the surgical procedure (odds ratio [OR], 1.004; 95% confidence interval [CI], 1.001 to 1.007), the cervical location for anastomosis (OR, 5.4; 95% CI, 1.3 to 22.9), and the development of an ARDS in the postoperative period (OR, 4.1; 95% CI, 2.6 to 176.5). Ninety-three patients benefited from an effective TEA for 4.4 +/- 0.8 days. The use of TEA was independently associated with a decrease in the incidence of anastomotic leakage (OR, 0.13; 95% CI, 0.02 to 0.71).Conclusions: The results of this retrospective study, suggest that TEA is associated with a decrease in occurrence of anastomotic leakage.