CAJ | 학술논문

目的：分别对以术后30 d死亡和术后90 d死亡计算的食管癌手术病死率在食管外科的临床意义进行评估。方法以2000—2012年由北京大学肿瘤医院胸外一科单一手术组完成的954例食管癌手术患者作为研究对象。由食管癌前瞻性数据库中提取术后30 d死亡和术后30～90 d死亡的病例，分别以术后30 d死亡和术后90 d死亡计算病死率，并分析死亡原因。结果术后30 d死亡11例，30 d病死率为1．1％（11／954）；术后30～90 d死亡9例，术后90 d共死亡20例，90 d病死率为2．1％（20／954）。术后30 d死亡原因包括：吻合口瘘导致呼吸衰竭死亡者3例，吻合口瘘放置支架后出血死亡者1例，术前呼吸道合并症加重导致呼吸衰竭死亡者3例，术前心血管合并症加重导致心脏意外死亡者2例，败血症死亡者1例，术后早期化疗毒性致多脏器衰竭死亡者1例。术后30～90 d死亡原因包括：吻合口瘘导致呼吸衰竭死亡者1例，术前心血管合并症加重导致心脏意外死亡者1例，术前肝硬化加重导致肝功能衰竭死亡者1例，术后肾功能衰竭死亡者1例，脑血管意外死亡者1例，肿瘤进展死亡者1例，术后早期化疗毒性致多脏器衰竭死亡者1例；另有2例死因不详。结论以术后30 d死亡计算的食管癌手术病死率低估了食管癌手术的风险。
목적：분별대이술후30 d사망화술후90 d사망계산적식관암수술병사솔재식관외과적림상의의진행평고。방법이2000—2012년유북경대학종류의원흉외일과단일수술조완성적954례식관암수술환자작위연구대상。유식관암전첨성수거고중제취술후30 d사망화술후30～90 d사망적병례，분별이술후30 d사망화술후90 d사망계산병사솔，병분석사망원인。결과술후30 d사망11례，30 d병사솔위1．1％（11／954）；술후30～90 d사망9례，술후90 d공사망20례，90 d병사솔위2．1％（20／954）。술후30 d사망원인포괄：문합구루도치호흡쇠갈사망자3례，문합구루방치지가후출혈사망자1례，술전호흡도합병증가중도치호흡쇠갈사망자3례，술전심혈관합병증가중도치심장의외사망자2례，패혈증사망자1례，술후조기화료독성치다장기쇠갈사망자1례。술후30～90 d사망원인포괄：문합구루도치호흡쇠갈사망자1례，술전심혈관합병증가중도치심장의외사망자1례，술전간경화가중도치간공능쇠갈사망자1례，술후신공능쇠갈사망자1례，뇌혈관의외사망자1례，종류진전사망자1례，술후조기화료독성치다장기쇠갈사망자1례；령유2례사인불상。결론이술후30 d사망계산적식관암수술병사솔저고료식관암수술적풍험。
Objective To summarize the mortality of esophagectomy in our series and compare the different mortalities based on 30-day deaths and 90-day deaths postoperatively. Methods A total of 954 patients undergoing esophagectomy by single-surgeon-team between January 2000 and December 2012 from our prospective database were enrolled. The mortalities based on 30-day and 90-day deaths postoperatively were compared, and the causes of deaths within 30 days and 90 days were analyzed. Results Among all these 954 patients, a total of 20 postoperative deaths (2.1%) were observed: 11 within 30 days (1.1%) and 9 between 30 and 90 days after surgery (1.0%). The reasons for deaths within 30 days were as follows: 3 for respiratory failure related to anastomotic leakage,1 for bleeding after stenting due to anastomotic fistula, 1 for sepsis, 3 for respiratory failure from presenting preoperative respiratory morbidities, 2 for cardiac arrest caused by preoperative heart disorder, and 1 for multiple organ failure caused by early adjuvant chemotoxicity. The reasons for deaths between 30 and 90 days were as follows: 1 for respiratory failure related to anastomotic leakage , 1 for cardiac arrest from preoperative heart disorder, 1 for cerebrovascular accident, 1 for liver failure from liver cirrhosis presenting preoperatively, 1 for renal failure after operation, 1 for tumor progression and 2 for unknown reasons. Conclusion Since postoperative mortality calculated based on 30 days deaths postoperatively may underestimate the risk of esophagectomy, mortality calculated based on 90 days may be a better option.