Analysis Of The Related Factors And Therapeutic Effect Of Esophagojejunostomy Leakage After Total Gastrectomy For Gastric Cancer

Objective To determine some factors that may increase the incidence of esophageal-jejunum anastomotic fistula in patients with gastric cancer after total gastrectomy,identify high-risk factors,and provide a basis for reducing the incidence of fistula,so as to reduce or avoid such high-risk factors clinically..For the patients who have had anastomotic fistulaand to explore the treatment of anastomotic fistula,the relevant treatment schemes were summarized actively,and the effective methods for the treatment of anastomotic fistula were discussed.Methods Collect The clinical data of 15 patients with esophageal-jejunum anastomotic fistula,and 218 patients without esophageal-jejunum anastomotic fistula in general surgery department of Anhui Medical University from July 2013 to October 2017,Chi-square test and logistic multivariate regression analysis were performed.Result Among the 15 cases of esophagojejunal anastomotic fistula,there were 10 males and 5female.Among them,14 patients were discharged after anastomotic fistula healed,and1 patient died.The average age was 66.13 ± 5.86 years,the minimum age was 51 years,and the maximum age was 78 years.Most of the tumor stages were later.In all patients,a nasoenteric nutrient tube was placed in the distal jejunal anastomosis,Among the 15 cases of esophagojejunal anastomotic fistula,12 cases still had nasoenteral nutrition tube when the fistula was found,2 cases were replaced with intervention,and 1 case was jejunal stoma fistula.2 cases had a large anastomotic fistula that leaked into the bilateral thorax,the effect of conservative treatment was notgood and septic shock was complicated in the two cases.After intervention,coated stent was placed on the fistula,The fistula soon improved significantly.Chi-square test showed that the incidence of esophagojejunal anastomotic fistula was related to four factors(diabetes mellitus,preoperative pulmonary insufficiency,hypertension,perioperative blood transfusion)(P < 0.05).There was no significant correlation with gender,age,long operation time,preoperative albumin level,preoperative hemoglobin,intraoperative blood loss,tumor size,location,depth of invasion,degree of differentiation,lymph node metastasis(P > 0.05).Multiva-riate analysis showed that diabetes mellitus,perioperative blood transfusion and pulmonary function incompetence are relatively independent risk factors of esophageal-jejunumanastomotic fistula after total gastrectomy.All patients with anastomotic fistula were treated with adequate drainage,acid suppression,enzyme inhibition,anti-inflammatory,nutritional support and so on.2 patients with anastomotic fistula were treated with covered stent.Conclusion Diabetes mellitus,perioperative blood transfusion and pulmonary function incompetenceeffects the healing of anastomotic fistula.Thetreatment of anastomotic fistula is mainly focused on tangible drainage,anti-infection,nutritional support.When postoperative anastomotic fistula is encountered,the placement of covered stent at the anastomotic fistula can also be considered for treatment.