不同手术方式中食管切除术后新发房颤与术后并发症和死亡率的相关性分析

Correlation Analysis of Atrial Fibrillation after Esophagectomy with Postoperative Complications and Mortality in Different Surgical Methods

摘要: 目的：探究不同手术方式中食管切除术后新发房颤与术后并发症和死亡率的相关性。方法：收集符合条件的青岛大学附属医院2018年1月到2020年12月行根治性食管切除术患者的临床资料。单因素和多因素logistic分析了食管切除术后新发房颤的危险因素。比较了总体及不同胸部手术方式中术后新发房颤与术后并发症和死亡率的相关性。结果：共收集到符合条件的491例患者的临床资料。共有71例(14.5%)的患者发生了术后新发房颤。单因素分析显示，高龄、BMI、慢性阻塞性肺疾病和胸部手术方式是新发房颤的危险因素；进一步多因素分析确定了高龄和BMI是房颤的危险因素。术后新发房颤组中，严重并发症、肺炎等肺部并发症、感染相关并发症的发生均高于无术后新发房颤组。在胸部开放手术中术后新发房颤与严重并发症，吻合口瘘和感染相关并发症有关(P < 0.05)，但是在微创手术中则没有显示出这种相关性(P > 0.05)。结论：食管切除术后新发房颤能增加术后并发症发生率和围术期死亡风险；对于胸部手术方式为微创的患者，术后新发房颤与并发症相关性有可能降低。

Abstract: Objectives: To explore the relationship between postoperative atrial fibrillation and postoperative complications and mortality in different surgical methods. Methods: The clinical data of eligible patients with radical esophagectomy from 2018-1 to December 2020 in the Affiliated Hospital of Qingdao University were collected retrospectively. The univariate and multivariate logistic analysis of risk factors for postoperative atrial fibrillation after esophagectomy was performed. And the correlation between postoperative atrial fibrillation and postoperative complications and mortality in overall and different chest surgery methods was compared. Results: A total of 491 eligible patients’ clinical data were collected. A total of 71 patients (14.5%) had postoperative atrial fibrillation. Univariate analysis showed that advanced age, BMI, chronic obstructive pulmonary disease and chest surgery methods were risk factors for new-onset atrial fibrillation; further multivariate analysis determined that advanced age and BMI were risk factors for atrial fibrillation. In the postoperative atrial fibrillation group, the incidence of severe complications, pneumonia, pulmonary complications, and infection-related complications were higher than those in the non-postoperative atrial fibrillation group. Postoperative atrial fibrillation in open chest surgery is associated with serious complications, anastomotic leakage and infection-related complications (P < 0.05), but this correlation was not shown in minimally invasive surgery (P > 0.05). Conclusions: Postoperative atrial fibrillation can increase the incidence of postoperative complications and mortality; for patients with minimally invasive thoracic surgery, the correlation between postoperative atrial fibrillation and complications may decrease.