下咽癌合并食管癌患者术后吻合口瘘危险因素分析

Analysis of Risk Factors for Postoperative Anastomotic Leakage in Patients with Hypopharyngeal Carcinoma Combined with Esophageal Cancer

摘要: 目的：探讨下咽癌合并食管癌患者手术治疗后发生吻合口瘘的危险因素，为及时识别和早期治疗吻合口瘘提供依据。方法：回顾性选取青岛大学附属医院2017年1月至2024年6月收治的行手术治疗的下咽癌合并食管癌患者53例。根据术后是否发生吻合口瘘分为吻合口瘘组和非吻合口瘘组，采用单因素分析及二元Logistic回归分析下咽癌合并食管癌患者术后发生吻合口瘘的危险因素。结果：53例下咽癌合并食管癌手术患者术后有7例出现吻合口瘘，发生率为13.21%。单因素分析结果显示2组合并糖尿病史、手术方式、术中有无输血、术前白细胞、术后第1天白细胞、术后第1天CRP、术后1周血红蛋白水平、术后1周CRP水平差异有统计学意义(< 0.05)，二元Logistic回归分析显示术后第一天白细胞水平、术后第一天CRP水平为下咽癌合并食管癌患者手术后发生吻合口瘘的独立危险因素(< 0.05)。结论：根据上述危险因素，临床应采取相应措施，预防吻合口瘘的发生，提高患者生存质量，改善患者预后。

Abstract: Objective: To investigate the risk factors for anastomotic leakage following surgical treatment in patients with hypopharyngeal carcinoma combined with esophageal cancer, and to provide a basis for timely identification and early treatment of anastomotic leakage. Methods A retrospective analysis was conducted on 53 patients with hypopharyngeal carcinoma combined with esophageal cancer who underwent surgical treatment at the Affiliated Hospital of Qingdao University from January 2017 to June 2024. The patients were divided into an anastomotic leakage group and a non-anastomotic leakage group based on the occurrence of anastomotic leakage postoperatively. Univariate analysis and binary logistic regression were used to identify the risk factors for anastomotic leakage. Results: Among the 53 patients, 7 developed anastomotic leakage, with an incidence rate of 13.21%. Univariate analysis revealed significant differences between the two groups in terms of diabetes history, surgical approach, intraoperative blood transfusion, preoperative white blood cell count, white blood cell count on the first postoperative day, CRP level on the first postoperative day, hemoglobin level one week postoperatively, and CRP level one week postoperatively (P < 0.05). Binary logistic regression analysis identified white blood cell count and CRP level on the first postoperative day as independent risk factors for anastomotic leakage (P < 0.05). Conclusion: Based on these independent risk factors, corresponding clinical measures should be taken to prevent anastomotic leakage, improve patients’ quality of life, and enhance prognosis.