Analysis And Prevention Of Risk Factors Of Esophageal-jejunum Anastomotic Leakage In Gastric Cancer Patients After Total Gastrectomy

Objective : Discuss the related risk factors of esophagus-jejunum anastomotic leakage after gastrectomy,to provide effective basis for preventing the occurrence of the EJAL after total gastrectomy.Method Collect the clinical data of 684 patients with gastric cancer treated by total gastrectomy from September 2013 to September 2016,which at gastrointestinal colorectal anal surgery department of Jilin university China-Japan fellowship hospital,and conduct Logistic regression analysis for single factor and multiple factors of postoperative esophageal-jejunal anastomotic leakage(EJAL).All the data with SPSS22.0 software for statistical analysis.Result There were 33 cases(4.8%)with esophagus-jejunum anastomotic leakage(EJAL)among 684 patients tread by gastric cancer operation,the average time is 6(4-12)d.The analysis of single factor showed that: The incidence of EJAL after total gastrectomy has statistical significance(P < 0.05)in the difference between such factors: age(> 65 years),diabetes mellitus,hypoalbuminemia(< 35 g/L),preoperative pulmonary functionincompetence(FEV1 < 70% or lung capacity < 80%),long operation time(> 240 min),while there has no statistical significance(P > 0.05)in the differences between gender,BMI,operation method(open/cavity mirror),anastomotic reinforcement status,TNM stage.Multiple factors logistic analysis showed: diabetes mellitus,preoperative hypoalbuminemia(<35g/L),preoperative pulmonary function incompetence(FEV1 <70% or lung capacity < 80%),long operation time(>240min)are relatively independent risk factors of esophageal-jejunum anastomotic fistula(EJAL)after total gastrectomy.Conclusion: Age(>65),diabetes,low serum albumin(<35g/L),pulmonary insufficiency(FEV1<70% or vital capacity<80%),long duration of operation(?240 min)and other factors is related risk factors of esophageal-jejunum anastomotic leakage in patients with total gastrectomy.Diabetes,low serum albumin(<35g/L),pulmonary insufficiency(FEV1<70% or vital capacity<80%),long duration of operation(?240 min)is relatively independent of the risk factors of esophageal-jejunum anastomotic leakage in patients with total gastrectomy.Patients with preoperative diabetes low serum albumin,pulmonary insufficiency should be taken care of during perioperative period and on the premise of radical operation to shorten the operation time to prevent the occurrence of EJAL.