【作者】 邢磊；

【导师】 张宏；

【作者基本信息】 吉林大学 ， 临床医学硕士（外科学）（专业学位）， 2020， 硕士

【摘要】 目的:分析微创Mckeown术后颈部吻合口瘘发病的危险因素,提出预防或减少微创Mckeown术后颈部吻合口瘘发生的方案,促使患者快速恢复,缩短平均住院时间,减轻经济负担。方法:本文分析吉林大学第一医院胸外科本治疗组2018年10月至2019年10月行微创Mckeown的38名食管癌患者。经查阅相关文献,结合患者病史、术前及术后检查结果、术中测量幽门到胃网膜右动脉末端长度(以下简称胃网膜右动脉长度)、幽门到管胃末端长度(以下简称管胃长度)、以及胃网膜右动脉长度占管状胃长度的比值。以上述数据为变量,对于计数资料应用t检验,计量资料行χ2检验,进行单因素分析吻合口瘘的相关危险因素。结果:本样本38例行微创Mckeown的食管癌患者,11例出现颈部吻合口瘘,术后颈部吻合口瘘发生率为28.9%(11/38)。此11例吻合口瘘患者经保守治疗均顺利康复出院,无围手术期死亡病例。分析结果显示:术后第1天血清白蛋白水平、术后肺部并发症、胃网膜右动脉长度、胃网膜右动脉与管胃长度比值是微创Mckeown术后吻合口瘘的独立危险因素(P<0.05)。结论:对于行微创Mckeown术式的食管癌患者,既往病史在术前应得到有效控制;胃网膜右动脉在管胃血供范围、术后第一天白蛋白水平以及术后肺部并发症是微创Mckeown术后颈部吻合口瘘的独立危险因素。对于吻合口瘘的高危患者应密切观察患者临床症状,尽早预防。更多还原

【Abstract】 Objective: To analyze the risk factors of cervical anastomotic leakage after minimally invasive Mckeown,and to propose a method to prevent and reduce cervical anastomotic leakage after minimally invasive Mckeown,so as to promote rapid recovery of patients,shorten the average hospitalization time and reduce the economic burden.Methods: A total of 38 patients in our group of thoracic surgery department of the First Hospital of Jilin University who underwent minimally invasive Mckeown,were analyzed from October 2018 to October 2019.Through the literature,in combination with the patient’s history and intraoperative preoperative testing results.The basic statistic is to measure the length of pylorus to the end of right gastroepiploic arteries,and the length of the gastric conduit,and the length of pylorus to the end of right gastroepiploic arteries ratio to the length of stomach tube as a variable.The t-test was used to compare the mean of continuous data,and Pearson’s χ2 test were used to compare categorical data.Results: There were 11 cases of cervical anastomotic leakage in 38 patients with cervical anastomosis after minimally invasive Mckeown.The incidence of cervical esophagogastric anastomotic leakage was 28.9%(11/38).After conservative treatment,all the 11 patients with anastomotic leakage recovered,and there were no deaths in hospital.The results of univariate analysis showed that serum albumin level on the first day after surgery,postoperative pulmonary complications,the length of right gastroepiploic artery,and the ratio of right gastroepiploic artery to gastric conduit length were independent risk factors for anastomotic leakage after minimally invasive Mckeown(P<0.05).Conclusion: For patients with esophageal cancer who underwent minimally invasive Mckeown surgery,previous medical history should be effectively controlled before surgery.The right gastroepiploic artery in the range of blood supply to the gastric conduit,albumin level on the first day after operation and postoperative pulmonary complications were independent risk factors for neck anastomotic fistula after minimally invasive Mckeown surgery.For patients with high risk of anastomotic leakage,clinical symptoms should be closely observed to prevent as soon as possible.更多还原