摘要
目的探讨影响胃代食管术患者围手术期死亡的危险因素。方法回顾性总结2008年10月至2017年10月在中国医学科学院北京协和医学院肿瘤医院头颈外科行全下咽食管切除胃代食管术的71例下咽食管癌患者资料,其中男64例,女7例,年龄35~72岁。选取17种可能影响胃代食管手术围手术期死亡的相关因素进行分析,对单因素分析差异有统计学意义的指标再进行多因素Logistic回归分析,分析影响胃代食管术患者围手术期死亡的独立危险因素。结果71例胃代食管手术患者中围手术期死亡7例(9.9%),生存64例(90.1%)。单因素分析发现,患者年龄、术前异常心电图、TNM分期、术后丙氨酸转氨酶变化、D-二聚体变化及术后出血6项指标对围手术期死亡差异的影响有统计学意义(P值分别为0.023、0.004、0.026、0.021、0.015、0.002)。多因素分析显示,术后出血以及术后D-二聚体改变是胃代食管手术围手术期死亡的独立危险因素(P=0.021;P=0.047)。结论胃代食管手术患者围手术期死亡是多因素作用的结果,术后出血及术后D-二聚体明显升高常常提示预后不良。
Objective To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods.Methods A total of 71 patients,including 64 males and 7 females,aged from 35 to 72 years old,with hypopharyngeal or cervical esophageal carcinoma,who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017,were reviewed retrospectively.Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis,and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression.Results The rate of perioperative mortality was 9.9%(7/71).Single factor Logistic regression analysis indicated that the age of patients,abnormal electrocardiogram,TNM stages,alanine aminotransferase and D-Dimer changes,postoperative bleeding were risk factors for the death of patients(P values were 0.023,0.004,0.026,0.021,0.015 and 0.002,respectively).Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047,respectively).Conclusions Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy.Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients,indicating poor prognosis.
作者
刘阳
安常明
刘杰
倪松
李正江
刘绍严
王晓雷
徐震纲
张宗敏
Liu Yang;An Changming;Liu Jie;Ni Song;Li Zhengjiang;Liu Shaoyan;Wang Xiaolei;Xu Zhengang;Zhang Zongmin(Department of Head and Neck Surgery,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2019年第11期837-842,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
修复外科手术
手术后并发症
死亡率
危险因素
围手术期
Reconstructive surgical procedures
Postoperative complications
Mortality
Risk factors
Perioperative period
