背景:本研究旨在确定IvorLewis食管切除术前动脉钙化与术后结局之间的关系。
方法:这是2013年至2018年IvorLewis食管切除术的单中心回顾性回顾。术前CT影像学检查,和动脉钙化分级(无,未成年人,或主要)在不同的位置。主要结局包括主要并发症(由Clavien-Dindo分类III-V定义),次要结局为90天再次手术。再入院,和死亡率。使用多变量逻辑回归模型(比值比,或;95%置信区间,CI)。
结果:从2013年到2018年,有100例患者接受了食管切除术(79%为男性,90%白色,中位年龄68岁),85%被归类为ASAIII。94例患者具有可及的术前影像学检查。观察到特定区域的动脉钙化:冠状动脉82个(主要为33例),54在主动脉瓣中,78在主动脉上动脉,79在胸主动脉中,82在腹主动脉,和71在髂总。此外,60例患者出现腹腔轴钙化,40名患者被列为主要患者。25例患者出现严重并发症。两名患者发生吻合口漏,1例患者发生移植物坏死。90天的再入院率是10%,再次手术为12%,死亡率为4%。关于单变量分析,主要冠状动脉钙化与主要并发症(OR4.04;95%CI1.34-12.16;p=0.02)和90天再入院(OR8.20;95%CI1.01-68.47;p=0.04)显著相关。然而,未发现90日再次手术或死亡率与动脉钙化之间存在显著关联.
结论:这项研究表明,术前冠状动脉钙化会增加术后并发症的风险,因为这可能是整体健康的代用品。尽管如此,内脏钙化与术后结局的相关性有待进一步探讨.
BACKGROUND: This study aimed to determine the relationship between preoperative arterial calcifications and postoperative outcomes after Ivor Lewis esophagectomies.
METHODS: This was a single-center retrospective review of Ivor Lewis esophagectomies from 2013 to 2018. Preoperative CT imaging was reviewed, and arterial calcifications were graded (absent, minor, or major) in various locations. The primary outcome included major complications (defined by the Clavien-Dindo classification III-V) and the secondary outcomes were 90-day reoperations, readmissions, and mortality. Significant associations (p < 0.05) between calcifications and outcomes on univariable analysis were evaluated using a multivariable logistic regression model (odds ratios, OR; 95% confidence intervals, CI).
RESULTS: One hundred patients underwent esophagectomies from 2013 to 2018 (79% male, 90% White, median age 68 years), and 85% were classified as ASA III. Ninety-four patients had accessible preoperative imaging. Arterial calcifications in specific areas were observed: 82 in coronary arteries (major in 33 patients), 54 in the aortic valve, 78 in supra-aortic arteries, 79 in the thoracic aorta, 82 in the abdominal aorta, and 71 in common iliac. Furthermore, 60 patients exhibited celiac axis calcifications, with 40 patients classified as major. Twenty-five patients experienced major complications. Anastomotic leak occurred in two patients, and graft necrosis occurred in one patient. Ninety-day readmission was 10%, reoperation was 12%, and mortality was 4%. On univariable analysis, major coronary artery calcifications were significantly associated with major complications (OR 4.04; 95% CI 1.34-12.16; p = 0.02) and 90-day readmissions (OR 8.20; 95% CI 1.01-68.47; p = 0.04). However, no significant associations were identified between 90-day reoperations or mortality and arterial calcifications.
CONCLUSIONS: This study demonstrated that preoperative coronary calcifications increase the risk of postoperative complications, as this may be a surrogate of overall health. Nonetheless, the correlation between splanchnic calcifications and postoperative outcomes needs further exploration.