Analysis Of Risk Factors Of Cervical Esophagogastric Anastomotic Leak After Esophagectomy

Objects:To analyze and explore the perioperative period risk factors of cervical esophagogastric anastomotic leak after esophagectomy,and to provide theoretical support for the prevention of cervical esophageal anastomotic leak.Methods :Retrospective analysis of the clinical data of 956 patients who underwent esophagectomy and cervical anastomosis from January 2012 to December 2016 in Department of thoracic surgery of the First Affiliated Hospital of Zhengzhou University.According to whether the occurrence of anastomotic leak after surgery is divided into two groups.Through the literature and combined with clinical observation,the choice of cervical esophagogastric anastomotic leak may be related to the occurrence of factors.Univariate analysis was used to identify the risk factors of cervical esophagogastric anastomotic leak.Logistic regression analysis was used to identify the independent risk factors of cervical esophagogastric anastomotic leak.Results:There were 117 cases of cervical esophagogastric anastomotic leak after operation.The incidence of anastomotic leak was 12.2%.Univariate analysis showed that gender,age,diabetes history,surgical methods,stomach tube production,operation time,postoperative pulmonary infection,postoperative fiberbronchoscope suction,postoperative mechanical ventilation,postoperative ICU treatment related with cervical esophagogastric anastomotic leak,there was significant difference between two groups(P<0.05);smoking history,drinking history,history of hypertension,history of heart disease,history of cerebrovascular disease,preoperative chemoradiotherapy,weight loss,HGB,ALB,BMI,FEV1%,tumor segmentation,surgical bleeding,anastomotic mode,embedding,pathological type,TNM staging,differentiation degree,lymph nodes with cervical esophagogastric anastomotic leak had no obvious relationship,the difference between the two groups was not statistically significant(P>0.05).Logistic regression analysis showed that the production of tubular stomach(OR=1.922,P=0.006),postoperative pulmonary infection(OR=2.907,P=0.000),postoperative fiberbronchoscope suction(OR=2.323,P=0.009)was an independent risk factor for cervical esophagogastric anastomotic leak.Conclusions : Male,age more than 65 years old,had a history of diabetes,laparoscopic surgery,stomach tube production,operation time more than 300 minutes,postoperative pulmonary infection,postoperative fiberbronchoscope suction,postoperative mechanical ventilation,postoperative ICU treatment is a risk factor for cervical esophagogastric anastomotic leak;stomach tube production,postoperative pulmonary infection and postoperative fiberbronchoscope suction are independent risk factors for cervical esophagogastric anastomotic leak.Prevention and control of risk factors can effectively reduce the incidence of cervical esophagogastric anastomotic leak.