摘要
目的:良性吻合口狭窄是食管切除术和食管胃重建术后常见的并发症。一些患者不得不经历几次内窥镜扩张。本研究旨在通过分析吻合口和管胃残端的形态学变化来研究术后早期内窥镜检查是否与良性吻合口狭窄的发展有关。方法:前瞻性收集2020年7月至2020年12月期间接受McKeown手术和管胃重建术后早期内镜检查的172例患者的资料。使用多变量逻辑分析探讨各种潜在危险因素之间的相关性，包括新辅助治疗、辅助治疗、黏膜缺损的严重程度和良性吻合口狭窄的发展。结果:共50名患者（29.0%）发展为良性吻合口狭窄，中位发展时间为90天，中位下内镜扩张次数为2次。吻合口无坏死或渗漏，管胃残端未发生吻合口狭窄。在多变量分析中，缺乏术后化疗是良性吻合口狭窄发生的唯一显著危险因素（P＝0.04）。共29名患者（58.0%）出现了顽固性吻合口狭窄。多因素分析显示，术后未进行放疗（P＝0.01）或化疗（P＝0.03）是顽固性吻合口狭窄的危险因素。无论辅助治疗方案如何，大多数顽固性吻合口狭窄都倾向于在术后早期发展。结论:术后早期内镜检查是一种安全的工具，不会增加吻合口坏死或渗漏的发生率。缺乏术后放化疗是顽固性吻合口狭窄发生的危险因素，而无症状黏膜缺损对吻合口和管胃残端的吻合口狭窄的发生仅有有限的预测价值。
Abstract
Objective:Benign anastomotic stricture represents a frequent complication after esophagectomy and esophagogastric reconstruction. Some patients had to go through several endoscopic dilations. This study was undertaken to investigate whether early endoscopic examinations after surgery was associated with benign anastomotic stricture development by analyzing morphological change of the anastomosis and gastric tube stump.Methods:Data of 172 patients with early endoscopic examinations following McKeown procedure and gastric tube reconstruction between July 2020 and December 2020 were prospectively collected. Correlations among various potential risk factors including neoadjuvant therapy, adjuvant therapy, severity of mucosal defect and development of benign anastomotic stricture were explored using multivariate logistic analysis.Results:Fifty patients (29.0%) had developed benign anastomotic stricture with a median of 90 days, requiring a median of 2 endoscopic dilations. No necrosis or leakage at anastomosis or gastric tube stump had ever developed anastomotic strictures. In multivariate analysis, lack of postoperative chemotherapy was the only significant risk factor for BAS (P=0.04). Twenty-nine patients (58.0%) had developed refractory anastomotic strictures. In multivariate analysis, lack of postoperative radiotherapy (P=0.01) and chemotherapy (P=0.03) were the risk factors for refractory anastomotic strictures. Most refractory anastomotic strictures had tendency to develop early after surgery regardless of the adjuvant therapy regimens.Conclusions:Early postoperative esophagogastric endoscopy is a safe tool that would not increase the incidence of anastomotic necrosis or leakage. Lack of postoperative radiotherapy or chemotherapy was associated with RAS, while asymptomatic mucosal defect had limited predictive value for the occurrence of anastomotic stricture at the anastomotic site and gastric stump.
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