■吻合口漏(AL)一直是食管切除术并胃导管重建的最严重并发症之一。在临床实践中,AL的危险因素很多。值得注意的是,食管胃吻合处的张力和胃导管的血液供应直接影响吻合的完整性。然而,对胃导管的张力和血液供应缺乏定量研究。细胞外基质胶原的变化反映了张力和血液供应,影响吻合的质量。这项研究旨在建立定量的胶原蛋白评分,以描述细胞外基质中胶原蛋白结构的变化,并识别术后AL高危患者。
■对213例患者进行了回顾性研究。收集基线时的临床和病理资料。对吻合胃端的“甜甜圈”标本进行了光学成像和胶原蛋白特征提取。最小绝对收缩和选择算子(LASSO)回归模型用于选择显著的胶原特征,计算胶原蛋白评分,并验证胶原蛋白评分对ALs的预测功效。
■LASSO回归分析揭示了胃甜甜圈中三个胶原相关参数:直方图平均值,直方图方差,和直方图能量。基于这一分析,我们建立了计算胶原蛋白评分的公式。单因素分析结果显示,AL组和非AL组之间的术前低白蛋白值(P=0.002)和胶原评分存在显着差异(P=0.001),多变量分析结果显示,AL组和非AL组之间的胶原评分存在显着差异(P=0.002)。实验和验证队列的曲线下面积(AUC)分别为0.978[95%置信区间(CI):0.931-0.996]和0.900(95%CI:0.824-0.951),分别。
■本文建立的胶原蛋白评分显示与AL相关,可用于预测接受食道切除术的患者的AL。
UNASSIGNED: Anastomotic leakage (AL) has always been one of the most serious complications of esophagectomy with gastric conduit reconstruction. There are many strong risk factors for AL in clinical practice. Notably, the
tension at the esophagogastric anastomosis and the blood supply to the gastric conduit directly affect the integrity of the anastomosis. However, there has been a lack of quantitative research on the
tension and blood supply of the gastric conduit. Changes in extracellular matrix collagen reflect
tension and blood supply, which affect the quality of the anastomosis. This study aimed to establish a quantitative collagen score to describe changes in the collagen structure in the extracellular matrix and to identify patients at high risk of postoperative AL.
UNASSIGNED: A retrospective study of 213 patients was conducted. Clinical and pathological data were collected at baseline. Optical imaging of the \"donut\" specimen at the anastomotic gastric end and collagen feature extraction were performed. Least absolute shrinkage and selection operator (LASSO) regression models were used to select the significant collagen features, compute collagen scores, and validate the predictive efficacy of the collagen scores for ALs.
UNASSIGNED: LASSO regression analysis revealed three collagen-related parameters in the gastric donuts: histogram mean, histogram variance, and histogram energy. Based on this analysis, we established a formula to calculate the collagen score. The results of the univariate analysis revealed significant differences in the preoperative low albumin values (P=0.002) and collagen scores between the AL and non-AL groups (P=0.001), while the results of the multivariate analysis revealed significant differences in the collagen scores between the AL and non-AL groups (P=0.002). The areas under the curve (AUCs) of the experimental and validation cohorts were 0.978 [95% confidence interval (CI): 0.931-0.996] and 0.900 (95% CI: 0.824-0.951), respectively.
UNASSIGNED: The collagen score established herein was shown to be related to AL and can be used to predict AL in patients who underwent esophagectomy.