Analysis Of Anastomotic Leakage After Esophagogastrostomy

Objectives Through the study of 146 esophageal cancer patients accepted esophagogastrostomy in our department,find the incidence situation in different parts(neck and chest)of esophageal anastomotic fistula.Analysis the clinical characteristics and treatment of anastomotic fistula.discuss the related factors of anastomotic fistula and find preventive measures.In order to reduce the incidence of the anastomotic fistula,And to provide basis for early diagnosis and prevention of anastomotic fistula.Method All these 146 cases were collected from thoracic surgery of Dalian Medical University affiliated hospital From January 2014 to January 2016,who were diagnosed with esophageal cancer and underwent esophagogastrostomy.Retrospectively analyzed the clinical data and divided them into two groups according to the anastomotic leakage after surgery.Options include gender,hypertension,diabetes,history of pulmonary disease,whether suffering from cardiovascular disease,preoperative low protein,preoperative radiotherapy,smoking,operation method,anastomosis site,postoperative pathologic,et al,14 clinical factors may lead to anastomotic fistula.Single factor analysis using continuous correction x2 inspection and Fisher's exact probability.According to the results of single factor analysis,using Spearman correlation analysis.And use Logistic regression analysis to find out the independent factors of anastomotic leakage.Discusse the different clinical manifestations and early preventions of anastomotic leakage,according to the position anastomotic leakage occurred(neck and chest).Results In the group of 146 cases,11 patients underwent esophagogastrostomy for esophageal carcinoma had anastomotic leakage(7.5%).8 of them recovered after conservative treatment,3 cases died due to lung infection and respiratory failure appeared in the process of treatment,the mortality rate was 27.3%.4 out of 29 cervical anastomosis cases had anastomotic leakage(13.8%);7 out of 117 intrathoracic anastomosis cases had anastomotic leakage,the morbidity rate was 6.0%.Postoperative pathological examination shows 131 cases of Squamous cell carcinoma,15 cases of adenocarcinoma.single factor analysis using continuous correction X2 inspection and Fisher's exact probability,the results showed : history of respiratory diseases,preoperative serum albumi <3.5g/d L,preoperative radiotherapy and operation time are Related factors affecting the anastomotic leakage.The difference was statistically significant(P<0.05).Spearman correlation analysis results showed:preoperative serum albumin <3.5 g/d L is negatively related to the anastomotic fistula(P<0.05);history of respiratory diseases,preoperative radiotherapy and operation time are Positively related to the anastomotic fistula(P<0.05).The Logistic regression analysis of multiple factors showed: preoperative serum albumin < 3.5g/d L(P=0.016OR=10.417),preoperative radiotherapy(P=0.035 OR=15.108),operation time(P=0.012OR=12.366)and history of respiratory diseases(P=0.025 OR=7.642)were independent risk factors lead to anastomotic leakage.Conclusion Esophageal carcinoma is a common malignant disease.Anastomotic leaks following esophagogastrostomy remain a major source of morbidity and mortality.Preoperative serum albumin < 3.5g/d L,preoperative radiotherapy,history of respiratory diseases and operation time are risk factors affecting the anastomotic leakage.Majority of patients with anastomotic fistula can be recovered after conservative treatment,rarely requires secondary surgery.Early diagnosis and dispose in time is the key to the prevention and treatment of esophageal anastomotic fistula.