Effect of reinforcement suture of anastomotic stoma during radical resection of esophageal carcinoma in prevention of postoperative anastomotic leakage

doi:10.3877/cma.j.issn.1674-0785.2021.06.002

Abstract

Abstract:

Objective

To evaluate the preventive effects of reinforcement suture of anastomotic stoma during radical resection of esophageal carcinoma on postoperative anastomotic leakage.

Methods

A total of 193 patients who underwent radical resection of esophageal carcinoma were collected at the Department of Thoracic Surgery II of Beijing Cancer Hospital between January 2016 and December 2018. They were divided into either a reinforcement suture group (70 cases) or a non-reinforcement suture group (control group, 123 cases). Esophagogastric anastomosis was performed by neck mechanical anastomosis in the control group. Reinforcement suture of anastomotic stoma was performed by transverse mattress suture in a figure-of-eight in the reinforcement suture group. After the surgery, the incidence of anastomotic leakage was recorded in the two groups. Multiple Logistic regression analysis was used to identify the independent risk factors for anastomotic leakage.

Results

After radical resection of esophageal carcinoma, the incidence of anastomotic leakage was significantly lower in the reinforcement suture group than in the control group (5.7% vs 17.9%, P=0.017). There was no anastomotic stoma stenosis or death in either group during 2 years of follow-up. Multiple Logistic regression analysis showed that reinforcement suture was an independent protective factor for anastomotic leakage (OR=0.291, 95%CI: 0.096-0.887, P=0.030).

Conclusion

Reinforcement suture of anastomotic stoma during radical resection of esophageal carcinoma is effective in reducing the risk of postoperative anastomotic leakage.

Key words: Radical resection of esophageal carcinoma, Reinforcement suture, Anastomotic leakage

Zhiwei Zhou, Liang Wang, Jianyi Yang, Miao Huang, Zeming Ma, Yue. Yang. Effect of reinforcement suture of anastomotic stoma during radical resection of esophageal carcinoma in prevention of postoperative anastomotic leakage[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(06): 407-411.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2021.06.002

https://zhlcyszz.cma-cmc.com.cn/EN/Y2021/V15/I06/407

Figures/Tables 2

项目	吻合口加固缝合组（70例）	对照组（123例）	统计值	P值
性别［例（%）］			χ²=1.136	0.287
男	63（90.0）	104（84.6）
女	7（10.0）	19（15.4）
年龄［例（%）］			χ²=6.042	0.014
≤65	60（85.7）	86（69.9）
＞65	10（14.3）	37（30.1）
病理类型［例（%）］			χ²=12.674	0.002
鳞癌	63（90.0）	120（97.6）
腺癌	6（8.6）	0（0）
其他	1（1.4）	3（2.4）
病理分期［例（%）］			χ²=0.344	0.951
1期	14（20.0）	25（20.3）
2期	29（41.4）	54（43.9）
3期	23（32.9）	39（31.7）
4期	4（5.7）	5（4.1）
手术方式［例（%）］			χ²=0.002	0.968
腹、右胸两切口	48（68.6）	84（68.3）
腹、颈、右胸三切口	22（31.4）	39（31.7）
伴有糖尿病［例（%）］			χ²=0.283	0.594
是	6（8.6）	8（6.5）
否	64（91.4）	115（93.5）
术前化疗［例（%）］			χ²=0.252	0.616
是	27（38.6）	43（35.0）
否	43（61.4）	80（65.0）
血红蛋白（g/L， $x ¯$ ±s）	135.86±17.72	137.81±14.30	t=-0.836	0.404
白蛋白水平（g/L， $x ¯$ ±s）	41.45±3.44	44.05±2.74	t=-5.419	＜0.001
BMI（kg/m²， $x ¯$ ±s）	22.14±2.39	23.16±2.57	t=-2.709	0.007

项目	吻合口加固缝合组（70例）	对照组（123例）	统计值	P值
性别［例（%）］			χ²=1.136	0.287
男	63（90.0）	104（84.6）
女	7（10.0）	19（15.4）
年龄［例（%）］			χ²=6.042	0.014
≤65	60（85.7）	86（69.9）
＞65	10（14.3）	37（30.1）
病理类型［例（%）］			χ²=12.674	0.002
鳞癌	63（90.0）	120（97.6）
腺癌	6（8.6）	0（0）
其他	1（1.4）	3（2.4）
病理分期［例（%）］			χ²=0.344	0.951
1期	14（20.0）	25（20.3）
2期	29（41.4）	54（43.9）
3期	23（32.9）	39（31.7）
4期	4（5.7）	5（4.1）
手术方式［例（%）］			χ²=0.002	0.968
腹、右胸两切口	48（68.6）	84（68.3）
腹、颈、右胸三切口	22（31.4）	39（31.7）
伴有糖尿病［例（%）］			χ²=0.283	0.594
是	6（8.6）	8（6.5）
否	64（91.4）	115（93.5）
术前化疗［例（%）］			χ²=0.252	0.616
是	27（38.6）	43（35.0）
否	43（61.4）	80（65.0）
血红蛋白（g/L， $x ¯$ ±s）	135.86±17.72	137.81±14.30	t=-0.836	0.404
白蛋白水平（g/L， $x ¯$ ±s）	41.45±3.44	44.05±2.74	t=-5.419	＜0.001
BMI（kg/m²， $x ¯$ ±s）	22.14±2.39	23.16±2.57	t=-2.709	0.007

变量	β值	SE	P值	OR值	95%CI
变量	β值	SE	P值	OR值	下限	上限
年龄	-0.015	0.491	0.975	0.985	0.376	2.578
BMI	0.006	0.087	0.948	1.006	0.849	1.192
病理类型	-0.157	0.611	0.798	0.855	0.258	2.834
白蛋白水平	-0.061	0.080	0.446	0.941	0.805	1.100
加固缝合	-1.233	0.568	0.030	0.291	0.096	0.887

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