目的:我们评估了预防性微型气管造口术(PMT)和他唑巴坦/哌拉西林(TAZ/PIPC)在食管切除术后高危患者围手术期的有效性。
方法:我们回顾性研究了在2013年1月至2021年12月期间接受食道癌切除术的89例连续高危患者。我们将具有以下两个或两个以上因素的患者定义为高风险:年龄≥70岁,性能状态≥1,呼吸功能障碍,肝功能障碍,心功能不全,肾功能不全,糖尿病,白蛋白<3.5g/dl,布林克曼指数>600。对前50名患者(标准组)进行标准管理。对接下来的39名患者(组合组)施用PMT和TAZ/PIPC。比较倾向评分匹配前后的患者特征和短期结果。
结果:在倾向得分匹配之前,24小时尿肌酐清除率,胸骨后路线,3野淋巴结清扫术,开腹入路更常见,术后肺炎(13%vs.36%,p=0.045)和≥3b级的并发症(2.6%vs.22%,p=0.01)频率较低,术后住院时间较短(中位数:23vs.28天,p=0.022)在联合组比在标准组。在倾向得分匹配中,患者特征,除了24小时肌酐清除率和重建途径,对23名配对患者进行匹配。术后肺炎(8.7%vs.39%,p=0.035)和≥3b级的并发症(0%与26%,p=0.022)频率较低,术后住院时间较短(中位数:22vs.25天,p=0.021)在联合组高于标准组。
结论:PMT联合TAZ/PIPC可以预防食管切除术后高危患者的术后肺炎。
OBJECTIVE: We evaluated the usefulness of prophylactic mini-tracheostomy (PMT) and perioperative administration of tazobactam/piperacillin (TAZ/PIPC) in high-risk patients after esophagectomy.
METHODS: We retrospectively studied 89 consecutive high-risk patients who underwent esophagectomy for esophageal cancer between January 2013 and December 2021. We defined patients with two or more of the following factors as high risk: age ≥70 years, performance status ≥1, respiratory dysfunction, liver dysfunction, cardiac dysfunction, renal dysfunction, diabetes mellitus, albumin <3.5 g/dl, and Brinkman index >600. Standard management was administered to the first 50 patients (standard group). PMT and TAZ/PIPC were administered to the next 39 patients (combination group). Patient characteristics and short-term outcomes were compared before and after propensity-score matching.
RESULTS: Before propensity-score matching, 24-hour urine creatinine clearance, retrosternal route, 3-field lymph node dissection, and open abdominal approach were more common, postoperative
pneumonia (13% vs. 36%, p=0.045) and complications of grade ≥3b (2.6% vs. 22%, p=0.01) were less frequent, and the postoperative hospital stay was shorter (median: 23 vs. 28 days, p=0.022) in the combination group than in the standard group. In propensity-score matching, patient characteristics, except for 24-h creatinine clearance and reconstructive route, were matched for 23 paired patients. Postoperative
pneumonia (8.7% vs. 39%, p=0.035) and complications of grade ≥3b (0% vs. 26%, p=0.022) were less frequent and postoperative hospital stay was shorter (median: 22 vs. 25 days, p=0.021) in the combination group than in the standard group.
CONCLUSIONS: PMT with TAZ/PIPC can potentially prevent postoperative
pneumonia in high-risk patients after esophagectomy.