| Objective:Studying the related risk factors of anastomotic fistula occurred in two different esophageal carcinoma radical resection of minimally invasive esophagectomy of thoracoscopic and laparoscopic esophageal McKeown surgery and thoracoscopic and laparoscopic esophageal Ivor-Lewis surgery,and providing reference for reducing the incidence and prevention and treatment of postoperative anastomotic fistula after radical resection of complete endoscopic esophageal carcinoma.Materials and methods:1.Clinical data:from March 2015 to December 2016,the clinical data of 75 patients with esophageal carcinoma who underwent radical resection of esophageal carcinoma in the Department of thoracic surgery of the First Affiliated Hospital of Kunming Medical University were collected according to the criteria of admission,62 males,13 cases of female,age 33 to 74 years old,with an average age of 58.±29.9years;Upper thoracic esophageal carcinoma in 1 case,middle thoracic esophageal carcinoma in 17 cases,and lower thoracic esophageal carcinoma in 57 cases.2.methods:(1)Surgical methods Complete endoscopic esophageal McKeown surgery in patients with upper and middle thoracic esophageal carcinoma(Three incision through the neck,right chest and upper abdomen),complete endoscopic esophageal Ivor-Lewis surgery was treated in patients with lower thoracic esophageal carcinoma(Two incision through right chest and upper abdomen).(2)The diagnosis of anastomotic fistula ① According to the patient’s clinical symptoms and signs,② Imaging examination,such as chest radiography,iodine water imaging of upper gastrointestinal tract,③ Pleural cavity puncture and gastroscopy.(3)Staging by the occurrence time(early,middle and late stage)of anastomotic fistula The early fistula was 1 to 3 days after operation,and the medium-term fistula of postoperative 4 to 14 days,and the late fistula was more than 2 weeks after surgery.(4)All the observed data using SPSS 17.0 software package to do statistical analysis.The gender,age,preoperative diabetes mellitus,history of hypertension,preoperative serum albumin level,respiratory system disease,surgery time,tumor location,pathological stage,surgical methods,indwelling gastric tube and anastomotic embedding multiple factors were analyzed,first of all,the single factor analysis,count data using X2 test,after using the binary Logistic regression statistical methods to analyze multivariate factors,with P<0.05 for the difference was statistically significant.Results:75 patients with esophageal carcinoma accepted complete endoscopic esophageal cancer surgery,postoperative anastomotic fistula occurred in 9 cases,the incidence rate was 12%(9/75),2 cases died,the case fatality rate was 22.2%(2/9).It was found that the time of anastomotic fistula was 5 to 10 days,and the median time was 8.5 days,All of the patients with anastomotic fistula in the 9 cases were middle term fistula,no fistula in the early and late fistula.Complete endoscopic esophageal McKeown surgery of 18 patients,anastomotic fistula occurred 3 cases,the incidence rate was 16.7%(3/18),no one death.57 cases of patients with complete endoscopic esophageal Ivor-Lewis surgery,anastomotic fistula occurred in 6 cases postoperatively,the incidence rate was 10.5%(6/57),including 4 cases of anastomotic fistula is larger,the maximum up to 1.8cm,1 case by placing jejunum nutrition tube failure,line jejunostomy,and anti-infection and nutrition support after symptomatic treatment 2 months the healing of the fistula was recovered;another 3 patients,1 cases of severe thoracic infection and secondary pulmonary infection led to the death of respiratory failure,1 cases of severe thoracic infection,poor systemic condition,giving up the treatment of automatic discharge,1 case of open chest line fistula repair and postoperative fistula closure stent failure,2 months later death from pyothorax sepsis,systemic failure.The results of single factor analysis showed that gender count data(X2=0.17,P=0.680),age(X2=2.98,P=0.084),preoperative whether diabetes mellitus(X2=2.85,P=0.092),history of hypertension(X2=1.65,P=0.199),tumor location(X2=0.77,P=0.681),pathological stage(X2=2.05,P=0.358),indwelling gastric tube(X2=0.04,P=0.840),anastomotic embedding(X2=0.10,P=0.748),P>0.05,there was no statistically significant difference in the incidence of anastomotic fistula.Preoperative albumin level(X2=6.60,P=0.010),respiratory diseases(X2=4.18,P=0.041),operation time(X2=4.37,P=0.037),surgery method(X2=0.49,P=0.048),P<0.05,the incidence rate of anastomotic fistula difference was statistically significant.Multi-factor binary Logistic regression analysis results showed that preoperative serum albumin levels of partial regression coefficient B=-1.769,P=0.008 ratio Exp(B)=0.170,respiratory diseases B=0.289,P=0.019,Exp(B)=1.335,operation time B=-0.144,P=0.003,Exp(B)=0.866,surgery method B=-0.870,P=0.000,Exp(B)=0.419 is the independent risk factors of anastomotic fistula in complete thoracoscopic after resection of esophageal cancer.Conclusions:Anastomotic fistula after complete endoscopic resection of esophageal cancer is given priority to with medium-term fistula,is the result of many factors.The incidence rate of anastomotic fistula in complete endoscopic esophageal Ivor-Lewis surgery was lower than that of complete endoscopic esophageal surgery(McKeown),but the fatality rate of intrathoracic anastomotic fistula was high.Active prevention can reduce the incidence of anastomotic fistula,once taken timely and effective treatment can reduce the case fatality rate of patients with anastomotic fistula. |
