Analysis And Treatment Of Risk Factors For Esophagogastric Anastomotic Leakage After Radical Resection Of Esophageal Cancer

Objective:To analyze the risk factors of esophagogastric anastomotic leakage after perioperative esophageal cancer resection,and to explore ways to prevent and reduce anastomotic leakage after esophageal cancer resection.Methods:To review the medical records of patients undergoing radical surgery for esophageal cancer in the Department of Thoracic Surgery,Second Affiliated Hospital of Kunming Medical University from January 2013 to December 2018.According to the inclusion criteria and exclusion criteria,62 patients with radical esophageal eaneer were screened.The oeeurrence of anastomotic leakage was divided into anastomotic hernia group and non-anastomotic hernia group.The differences between the two groups were compared and analyzed.Through clinical observation and review of relevant literature,patients were selected for age,gender,hypertension,diabetes,smoking history,preoperative albumin,operative time,surgical procedure,tumor location,anastomotic location,intraoperative blood loss,and postoperative incidence.Pulmonary infection,postoperative N stage,T stage,pathological stage,ASA score,first day postoperative drainage,preoperative FEVI,FEV1/FVC,preoperative and postoperative first day red blood cells,white blood cells,hemoglobin,neutral Granulocyte value.Univariate analysis of the above factors was conducted to screen out the risk factors for anastomotic leakage.Among them,the independent sample T test was used for the measurement data that conformed to the normal distribution,and the chi-square test was used for the classification data.Logistic regression analysis was used to screen out independent risk factors for anastomotic leakage in patients after radical resection of esophageal cancer.Results:Sixty-two patients with anastomotic leakage occurred after radical resection of esophageal cancer in 62 patients in this study.The incidence of anastomotic leakage was 9.7%(6/62),including 3 cases of anastomotic leakage in the neck and 3 cases of anastomotic hernia in the chest(2 cases on the arch and 1 case under the bow).Univariate analysis showed:patient age(P=0.024),preoperative albumin(P=0.000),operative time(P=0.002),postoperative pulmonary infection(P=0.009),postoperative N stage(P=0.014)),the difference between the two groups was statistically significant,P<0.05;gender,hypertension,diabetes,smoking history,tumor location,surgical approach,anastomotic loeation,pathological stage,T stage,ASA score,intraoperative blood loss,The first day after operation,the pre-existing FEVI,FEV1/FVC,red blood cells,white blood cells,hemoglobin and neutrophil values before and after the first day of operation,these factors P?0.05,the difference was not statistically significant.Multivariate analysis by logistic regression model showed preoperative albumin(P=0.005,OR=0.442),operative time(P=0.008,OR=1.017)and postoperative pulmonary infection(P?0.0145 OR=16.538)are independent risk factors for anastomotic leakage.Conclusions:1.Preoperative albumin,postoperative pulmonary infection,and operation time are independent risk factors for anastomotic leakage in patients after radical resection of esophageal cancer.A2.For patients with esophageal cancer resection,nutritional support should be strengthened in perioperative patients,respiratory management should be strengthened,lung infection should be prevented,and the risk of anastomotic leakage should be reduced.3.Early diagnosis and early active treatment are the key to the treatment of anastomotic leakage.For most anastomotic fistulas,they can generally heal through active conservative treatment.