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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2016, Vol. 03 ›› Issue (01) : 15 -20. doi: 10.3877/cma.j.issn.2095-8773.2016.01.015

所属专题： 专题评论； 文献；

论著

基于累积评分的食管癌术后吻合口瘘的风险分级系统
张磊1, 李辉1,†(), 侯生才1, 苗劲柏1   
  1. 1. 100020　北京，首都医科大学附属北京朝阳医院胸外科
  • 收稿日期:2016-01-08 出版日期:2016-02-28
  • 通信作者: 李辉

An aggregate score system to stratify the risk of anastomotic leakage after esophageal carcinoma surgery

Lei Zhang1, Hui Li1,†(), Shengcai Hou1, Jinbai Miao1   

  1. 1. Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2016-01-08 Published:2016-02-28
  • Corresponding author: Hui Li
  • About author:
    Corresponding author:Li Hui, Email:
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引用本文：

张磊, 李辉, 侯生才, 苗劲柏. 基于累积评分的食管癌术后吻合口瘘的风险分级系统[J]. 中华胸部外科电子杂志, 2016, 03(01): 15-20.

Lei Zhang, Hui Li, Shengcai Hou, Jinbai Miao. An aggregate score system to stratify the risk of anastomotic leakage after esophageal carcinoma surgery[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(01): 15-20.

目的

建立食管恶性肿瘤术后吻合口瘘并发症的风险分级系统，为食管癌切除术后发生胃食管吻合口瘘风险分级，识别潜在的高危患者。

方法

回顾性收集2010年1月至2015年1月于北京朝阳医院胸外科接受食管癌手术患者的临床资料，共285例食管癌患者被纳入分析。对术后胃食管吻合口瘘的潜在危险因素进行单因素分析和Logistic多因素回归分析，确定影响食管恶性肿瘤术后吻合口瘘的独立预测因素；并根据预测因素的权重进行赋值，最终建立食管恶性肿瘤术后吻合口瘘并发症的风险分级系统。

结果

全组患者术后食管胃吻合口瘘发生率为9.5%(27/285)，院内病死率为2.8% (8/285)。Logistic多因素回归分析发现，颈部吻合、年龄>69岁及血浆白蛋白<25 g/L是食管癌术后吻合口瘘的独立危险因素。每个独立危险因素均赋值1分，根据患者累积评分进行分组，其中0、1、2、3分组术后吻合瘘的发生率分别为2.2%、7.4%、21.0%和37.5%。

结论

食管恶性肿瘤术后吻合口瘘风险分级系统，临床可操作性强，可识别食管癌术后吻合口瘘的高危患者。

关键词: 食管恶性肿瘤, 吻合口瘘, Logistic回归, 赋值
Objective

To develop an aggregate score system to stratify the risk of anastomotic leakage after esophageal carcinoma surgery so as toscreen the patients with high risk for post-operative anastomotic leak.

Methods

The clinical data of patients undergoing esophageal carcinoma surgery in Department of Thoracic Surgery, Beijing Chaoyang Hospital between January 2010 and January 2015 were retrospectively collected, and a total of 285 patients were included for analysis. The independent risk factors for anastomotic leak after surgery were determined by univariate analysis and multivariate Logistic regression analysis. The scoring system was developed by proportional weighing of the independent risk factors, and patients were grouped into different classes according to their total score.

Results

The incidence of anastomotic leak after operation was 9.5%(27/285), and the in-hospital mortality was 2.8%(8/285). Multivariate Logistic regression analysis revealed that the site of anastomosis(neck), age (>69 years) and hypoalbuminemia (<25 g/L) were independently correlated with anastomotic leak after esophageal carcinoma surgery. With each risk factor receiving weighted score of 1, the patients were divided into 4 groups with an increased incidence of anastomotic leak: score 0 group, 2.2%; score 1 group, 7.4%; score 2 group, 21.0%; and score 3 group, 37.5%.

Conclusions

The aggregate score system is a reliable and practical tool for identifying patients with high risk of developing anastomotic leak after esophageal carcinoma surgery.

Key words: Esophageal carcinoma, Anastomotic leak, Logistic regression, Scoring system
表1 290例患者一般情况及临床资料
变量 [例数(%)]或(±s)
吻合口瘘 27(9.5%)
性别 ?
? 男性 238(83.5%)
? 女性 47(16.5%)
年龄(岁) 62.4±9.5
BMI(kg/m2) 22.8±3.6
吸烟史 190(66.7%)
糖尿病 25(8.8%)
高血压 65(22.8%)
血浆白蛋白(g/L) 25.6±3.0
术前血红蛋白(g/L) 135.0±14.1
手术方式 ?
? 开胸 255(89.5%)
? 全腔镜 30(10.5%)
管状胃 156(54.7%)
手术时间(h) 3.8±1.3
术中出血量(ml) 282.3±261.3
吻合位置 ?
? 胸内 227(79.6%)
? 颈部 58(20.4%)
病理类型 ?
? 鳞癌 199(69.8%)
? 腺癌 73(25.6%)
? 其他 13(4.6%)
T分期 ?
? Ⅰ 31(10.9%)
? Ⅱ 62(21.8%)
? Ⅲ 176(61.8%)
? Ⅳ 16(5.6%)
表2 食管癌术后吻合口瘘风险因素的单因素分析[(例数(%)或±s]
风险因素 吻合口瘘 无吻合口瘘 χ2/t值 P值
性别(男) 23(85.2%) 215(83.3%) 0.1 1.00
年龄(岁) 66.1(9.6) 62.0(8.6) 2.2 0.03
BMI(kg/m2) 22.4±3.6 22.8±3.6 0.8 0.57
吸烟史 17(63.0%) 173(67.1%) 0.2 0.67
糖尿病 2(7.4%) 23(8.9%) 0.1 1.00
高血压 6(22.2%) 59(22.9%) 0.1 1.00
白蛋白(g/L) 24.1±3.1 25.8±2.9 2.8 0.01
血红蛋白(g/L) 133±10.85 135.25±14.35 0.6 0.43
手术方式(开胸) 26(96.3%) 229(88.8%) 1.5 0.33
管状胃 13(48.1%) 143(55.4%) 0.5 0.54
手术时间(h) 3.5±2.0 3.2±1.6 0.3 0.65
T分期 一 一 0.8 0.86
病理类型(鳞癌) 20(74.1%) 179(69.4%) 1.4 0.49
年龄>69岁 14(51.9%) 63 (24.4%) 9.3 0.01
血浆白蛋白<25 g/L 19(70.4%) 116 (45.0%) 6.3 0.02
图1 年龄预测食管癌术后吻合口瘘的ROC曲线
图2 血浆白蛋白(ALB)预测食管癌术后吻合口瘘的ROC曲线
表3 食管癌术后吻合口瘘的多因素Logistic回归分析
变量 回归系数 P值 OR值(95%CI)
吻合位置 1.33 <0.01 3.78(1.60～8.92)
年龄 1.21 0.01 2.84(1.45～7.76)
白蛋白 1.10 0.02 2.59(1.22～7.34)
图3 食管癌不同评分组术后吻合瘘发生率变化趋势
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