| Objective: to identify and discuss the risk factors of cervical gastroesophageal anastomotic fistula in perioperative period of Total Mesoesophageal Excision for esophageal cancer under minimally invasive endoscopy by means of retrospective clinical study,attempt to provide a theoretical basis for exploring and formulating preventive measures to reduce the occurrence of cervical anastomotic fistula.Methods: from August 2014 to December 2017,405 patients who underwent minimally invasive thoracoscopic laparoscopic total mesoesophageal excision for esophageal cancer were collected.After screening by inclusion and exclusion criteria,398 patients were enrolled in this study.Patients with postoperative cervical anastomotic fistula and those without were included into study group A and control group B,respectively.By reading,browse relevant literature,selected 16 indicators as a candidate risk factor for cervical anastomotic fistula occurred,were age,sex,body mass index(BMI),smoking history,drinking history,conformal radiation therapy(CRT),tumor segment esophagus,blood loss,operative time,tumor pathological type,TNM stage,tumor differentiation degree(G grade),cleaning the lymph nodes,sputum suction postoperative bronchoscope,lung infection after operation,postoperative chylothorax.Relevant datas were collected for medical statistics,and the results were analyzed to summarize the risk factors and independent risk factors of cervical anastomotic fistula in perioperative period of minimally invasive total mesoesophageal excision for esophageal cancer.Results: the total number of patients was 398,including 57 cases of postoperative cervical anastomotic fistula,with an incidence of 14.32%.Single factor statistical analysis results points out that the age,sex,body mass index(BMI),smoking history,drinking history,conformal radiation therapy(CRT),esophageal tumor stage,pathological N stage,clinical M stage,cleaning lymph node and postoperative chylothorax is not risk factor for cervical anastomotic fistula,control group B group had no statistical difference(P≥0.05);Tumor pathological type,tumor differentiation degree(G grade),T stage in TNM stage,operation time,blood loss,postoperative pulmonary infection and postoperative tracheal aspiration were risk factors for cervical anastomotic fistula,and there were statistical differences between group A and group B(P <0.05).Multivariate Logistic regression analysis indicated that the degree of tumor differentiation(G grade)(P = 0.03),T stage(P = 0.01),operation time(P = 0.00)and postoperative pulmonary infection(P = 0.00)were independent risk factors for cervical anastomotic fistula.Conclusion: this study suggests tumor pathological type,tumor differentiation degree(G grade),T stage,operative time,blood loss,postoperative pulmonary infection and postoperative bronchoscope sputum suction can be regarded as perioperative risk factors participate in the whole series of minimally invasive esophageal cancer incidence of cervical anastomotic fistula after membrane resection,classification of G,T stage,operative time,postoperative pulmonary infection as an independent risk factor.Positive and effective clinical intervention or preventive elimination of interventional risk factors can theoretically reduce the incidence of postoperative cervical anastomotic fistula. |
