食管切除术后颈部吻合口狭窄的危险因素:早期术后内镜检查的发现
Risk factors of cervical anastomotic stricture after esophagectomy detected by early postoperative endoscopy.
作者
作者单位
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan.
- Department of Gastroenterological Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan. kimura.yasue.740@m.kyushu-u.ac.jp.
- Department of Hepatobiliary-Pancreatic Surgery, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan.
摘要
中文
颈部重建食管切除术后吻合口狭窄仍是临床上重要的并发症,但有效的预防策略有限。本研究旨在阐明术后第14天内镜检查结果对预测后续吻合口狭窄的临床意义。本回顾性单中心队列研究纳入2021年4月至2023年12月间接受经胸食管切除术并颈部重建的106例食管癌患者。采用线性切割吻合器以三角钉合技术完成颈部食管胃吻合。术后第14天(POD)行内镜检查。吻合口狭窄定义为1年内需行内镜球囊扩张的管腔狭窄。通过多因素分析评估POD 14内镜发现与后续狭窄之间的关联。探索性分析评估了与溃疡形成相关的因素。16例患者(15%)发生吻合口狭窄。POD 14的溃疡形成和食管水肿是狭窄的独立危险因素(均P = 0.03)。溃疡的环周范围越大,狭窄风险越高(P = 0.001)。探索性分析显示,POD 7的C反应蛋白升高(P = 0.004)及跨越胸廓入口的吻合(P = 0.08)与溃疡形成相关。POD 14内镜检查观察到的溃疡是食管切除术后后续吻合口狭窄的重要预测因子。早期术后内镜评估可能有助于识别后续吻合口狭窄风险增加的患者,并支持术后随访中的风险分层。
English
Anastomotic stricture after esophagectomy with cervical reconstruction remains a clinically significant complication, yet effective preventive strategies are limited. This study aimed to clarify the clinical significance of endoscopic findings on postoperative day 14 for predicting subsequent anastomotic stricture. This retrospective single-center cohort study included 106 patients with esophageal cancer who underwent transthoracic esophagectomy with cervical reconstruction between April 2021 and December 2023. Cervical esophagogastric anastomosis was performed using a triangulating stapling technique with a linear stapler. Endoscopy was performed on postoperative day (POD) 14. Anastomotic stricture was defined as luminal narrowing requiring endoscopic balloon dilation within 1 year. Associations between POD 14 endoscopic findings and subsequent stricture were assessed using multivariable analysis. Exploratory analyses evaluated factors associated with ulcer formation. Anastomotic stricture occurred in 16 patients (15%). Ulcer formation and esophageal edema on POD 14 were independent risk factors for stricture (both P = 0.03). Greater circumferential ulcer extent was significantly associated with higher stricture risk (P = 0.001). Exploratory analyses showed that elevated C-reactive protein on POD 7 (P = 0.004) and an anastomosis located across the thoracic inlet (P = 0.08) were associated with ulcer formation. Ulceration observed on POD 14 endoscopy is a significant predictor of subsequent anastomotic stricture after esophagectomy. Early postoperative endoscopic assessment may help identify patients at increased risk of subsequent anastomotic stricture and support risk stratification during postoperative follow-up.
分类与指标
- 研究类型
- 临床研究
- 病种
- 食管癌
- JCR 分区
- Q1
- 影响因子
- 11.8
- 新锐分区
- 1区