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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2014, Vol. 01 ›› Issue (01) : 41 -47. doi: 10.3877/cma.j.issn.2095-8773.2014.01.009

所属专题： 文献；

论著

食管癌术后再入重症监护病房患者的严重并发症特征分析
杨玉赏1, 彭俊1, 王文凭1, 胡杨1, 王允1, 陈龙奇1,†()   
  1. 1. 610041　成都，四川大学华西医院胸外科
  • 收稿日期:2014-08-24 出版日期:2014-11-28
  • 通信作者: 陈龙奇

Characteristics analysis of severe complications in patients with esophageal cancer for readmission to intensive care unit following esophagectomy

Yushang Yang1, Jun Peng1, Wenping Wang1, Yang Hu1, Yun Wang1, Longqi Chen1,†()   

  1. 1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2014-08-24 Published:2014-11-28
  • Corresponding author: Longqi Chen
  • About author:
    Corresponding author: Chen Longqi, Email:
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杨玉赏, 彭俊, 王文凭, 胡杨, 王允, 陈龙奇. 食管癌术后再入重症监护病房患者的严重并发症特征分析[J]. 中华胸部外科电子杂志, 2014, 01(01): 41-47.

Yushang Yang, Jun Peng, Wenping Wang, Yang Hu, Yun Wang, Longqi Chen. Characteristics analysis of severe complications in patients with esophageal cancer for readmission to intensive care unit following esophagectomy[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2014, 01(01): 41-47.

目的

探讨食管癌术后严重并发症的特征及其变化特点。

方法

2009年1月至2013年12月在华西医院胸外科接受食管癌切除术患者共3171例，其中因术后严重并发症再次转入重症监护病房(ICU)的患者153例，再入率为4.8%。收集153例患者的基本信息、并发症情况以及治疗结局，并进行回顾性分析。同时通过计算机系统检索有关食管癌术后并发症的临床研究，检索时间截至2014年1月。

结果

153例再入ICU患者中死亡68例。肺部并发症、吻合口和心血管并发症是最常见的致死性并发症，发生率分别为2.7%(85/3171)、0.9%(29/3171)和0.3%(10/3171)，病死率分别为1.1%(35/3171)、0.5%(15/3171)和0.2%(5/3171)。ICU获得性肺炎会增加死亡风险。多因素回归分析显示，患者再入ICU的时间间隔是死亡的独立危险因素(P＝0.044，OR＝2.151，95% CI为1.022～4.528)。分析总结相关文献，食管癌术后严重并发症根据年代可分为3个特征性时间段：1950年之前，顺序为休克、外科感染；1950至1980年间，顺序为吻合口瘘、肺部并发症；而1980年后，常见严重并发症顺序为肺部并发症、吻合口并发症和心血管并发症。

结论

食管癌切除术仍具有较高的风险，再入ICU可以成为反映其严重程度的标准。目前，肺部并发症已成为食管癌术后最主要的致死性并发症，其次为吻合口并发症和心血管并发症。

关键词: 食管癌, 食管癌切除术, 食管癌，并发症, 重症监护室
Objective

To analyse the features of severe postoperative complications in patients with esophageal cancer.

Methods

Methods A total of 3 171 patients underwent esophagectomy in Department of Thoracic Surgery, West China Hospital between January 2009 and December 2013, among whom 153 suffered from severe postoperative complications and were transferred to intensive care unit(ICU) for a second time, with the readmission rate of 4.82%. The baseline information, incidence of complicaitions and treatment outcomes were retrospectively analyzed. Meanwhile, the literatures published before February 2014 concerning complications following esophagectomy were also retrieved.

Results

Sixty-eight patients with readmission to ICU died. Pulmonary complication was the most frequent and lethal cause resulting in readmission to ICU [morbidity, 2.7%(85/3171); mortality, 1.1%(35/3171)], followed by anastomotic complication [morbidity, 0.9%(29/3171); mortality, 0.5%(15/3171)] and cardiovascular complication [morbidity, 0.3%(10/3171); mortality, 0.2%(5/3171)]. Acquired pneumonia attack following non-pulmonary complication could increase death risk significantly. Multivariate logistic regression analysis indicated that the time interval to readmission was an independent risk factor for death (P=0.044, OR=2.151, 95% CI: 1.022-4.528). Literature analysis demonstrated that the leading severe complications following esophagectomy by order were shock and surgical infection before 1950, anastomotic leak and pulmonary complications between 1950 and 1980, and pulmonary, anastomotic and cardiovascular complications after 1980.

Conclusion

Esophagectomy remains high risk of severe postoperative complications causing in-hospital mortality. Readmission to ICU could reflect the severity of complications following esophagectomy. Pulmonary complication is now the most frequent cause of postoperative death after esophagectomy, followed by anastomotic and cardiovascular complications.

Key words: Esophageal neoplasm, Esophagectomy, Esophageal neplasm, Complication, Intensive care unit
表1 153例食管癌术后再入ICU患者的基本信息
基本信息 例数
肿瘤位置 ?
? 上段 15
? 中段 97
? 下段 27
? 胃食管交界 14
手术方式 ?
? 左开胸 110
? Ivor-Lewis 5
? McKeown 17
? 胸腔镜 21
病理类型 ?
? 鳞癌 132
? 腺癌 21
TNM分期 ?
? ⅠA 2
? ⅠB 6
? ⅡA 6
? ⅡB 65
? ⅢA 52
? ⅢB 14
? ⅢC 8
表2 68例非肺部并发症再入ICU后继发获得性肺炎患者死亡情况
组别 总病例数 并发症(例数) 病死率(%)
吻合口并发症 心血管并发症 二次手术 其他
未继发肺炎组 34 6 1 0 1 23.5
继发肺炎组 34 9 4 3 2 52.9
表3 153例食管癌术后再入ICU患者的原发并发症分类
并发症种类 总病例数 并发症发生率(%) 死亡病例 病死率(%)
肺部并发症 85 2.7 35 1.1
? 肺炎 76 ? 31 ?
? 肺栓塞 3 ? 2 ?
? 痰潴留 4 ? 1 ?
? 支所管哮喘发作 1 ? 0 ?
? 大咯血 1 ? 1 ?
吻合口并发症 29 0.9 15 0.5
? 胃食管吻合口瘘 14 ? 7 ?
? 气道-食管瘘 6 ? 2 ?
? 主动脉-食管瘘 4 ? 4 ?
? 胸胃瘘 4 ? 2 ?
? 结肠吻合口瘘 1 ? 0 ?
心血管并发症 10 0.3 5 0.2
? 心搏骤停 5 ? 4 ?
? 严重心律失常 3 ? 0 ?
? 急性心力衰竭 2 ? 1 ?
二次手术 24 0.8 3 0.1
? 乳糜胸 10 ? 2 ?
? 出血 7 ? 0 ?
? 膈疝 3 ? 0 ?
? 腹壁切口疝 2 ? 1 ?
? 肺大疱破裂 1 ? 0 ?
? 脓胸 1 ? 0 ?
其他并发症 5 0.2 3 0.1
? 脓毒血症 2 ? 2 ?
? 脑梗死 2 ? 1 ?
? 胰瘘 1 ? 0 ?
总计 153 4.8 61 1.9
表4 食管癌术后患者再入ICU后死亡危险因素Logistic多因素回归分析
指标 危险因素及编码 回归系数 Wald值 P值 OR值 95% CI
年龄 ? ? ? ? ?
? (4＝40～49岁，5＝50～59岁，6＝60～69岁，7＝70～79岁，8＝80岁以上) 0.081 0.175 0.676 1.084 0.742～1.586
性别 ? ? ? ? ?
? (0＝男，1＝女) －0.066 0.018 0.892 0.936 0.359～2.440
原发并发症种类 ? ? ? ? ?
? (1＝肺部，2＝吻合口，3＝心血管，4＝二次手术，5＝其他) －0.128 0.323 0.570 0.880 0.566～1.368
肺炎 ? ? ? ? ?
? (0＝否，1＝是) 0.441 0.465 0.495 1.554 0.438～5.510
多重并发症 ? ? ? ? ?
? (0＝否，1＝是) 0.485 0.791 0.374 1.624 0.558～4.724
再入ICU时间 ? ? ? ? ?
? (0表示POD<1周，1表示POD≥1周) 0.766 4.064 0.044 2.151 1.022～4.528
ICU住院时间 ? ? ? ? ?
? (0表示<1周，1表示≥1周) 0.649 2.899 0.089 1.913 0.907～4.037
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