nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-180-8-87-92nogr-1432Research ArticleХИРУРГИЧЕСКАЯ ГАСТРОЭНТЕРОЛОГИЯSURGICAL GASTROENTEROLOGYНаличие коморбидности ухудшает прогноз эзофагопластикиImpact of comorbidity on complications and outcomes of esophagoplastyПлаксинС. А.PlaksinS. A.

Плаксин Сергей Александрович - профессор кафедры хирургии с курсом сердечно-сосудистой хирургии и инвазивной кардиологии, доктор медицинских наук, профессор.

Пермский край, Пермь, ул. Петропавловская, 26, 614000

Sergei A. Plaksin - professor of the Department of Surgery with Cardiovascular Surgery course, MD, professor.

614000, Perm, st. Petropavlovskaya, 26

splaksin@mail.ruХрацоваН. И.KhramtsovaN. I.

Храмцова Наталья Игоревна - доцент кафедры госпитальной хирургии, кандидат медицинских наук.

Пермский край, Пермь, ул. Петропавловская, 26, 614000

Natalia I. Khramtsova - associate professor of the Department of Hospital Surgery, Cand. of Sci.

614000, Perm, st. Petropavlovskaya, 26

ПономареваМ. А.PonomarevaM. A.

Пономарева Марина Александровна - ординатор кафедры хирургии с курсом сердечно-сосудистой хирургии и инвазивной кардиологии.

Пермский край, Пермь, ул. Петропавловская, 26, 614000

Marina A. Ponomareva - fulltime postgraduate student of the Department of Surgery with Cardiovascular Surgery Course.

614000, Perm, st. Petropavlovskaya, 26

СаблинЕ. Е.SablinE. E.

Саблин Евгений Евгеньевич - врач торакального хирургического отделения.

614990, Пермь, ул. Пушкина, д. 85

Evgeniy E. Sablin - Doctor at the Thoracic Surgery Department.

614990, Perm, st. Pushkin, 85

Федеральное государственное бюджетное образовательное учреждение «Пермский государственный медицинский университет имени академика Е.А. Вагнера» Министерства здравоохранения Российской ФедерацииРоссияPerm State Medical University named after Academician E.A. Wagner (PSMU)Russian FederationГосударственное бюджетное учреждение здравоохранения Пермского края Ордена «Знак Почета» Пермская краевая клиническая больницаРоссияPerm regional clinic hospitalRussian Federation202018102020088792Copyright © Плаксин С.А., Храцова Н.И., Пономарева М.А., Саблин Е.Е., 20202020Плаксин С.А., Храцова Н.И., Пономарева М.А., Саблин Е.Е.Plaksin S.A., Khramtsova N.I., Ponomareva M.A., Sablin E.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1432

Цель работы — оценить характер коморбидной патологии при эзофагопластике и ее влияние на результаты лечения.

Материалы и методы

Материалы и методы. 289 пациентов оперированы по поводу рака (251) и доброкачественных заболеваний пищевода (48), проанализированы коморбидный фон, индексы Чарлсона и Онодера.

Результаты

Результаты. У 92 (31,8%) коморбидных пациентов индекс Чарлсона равнялся 2,4±1,1. У пациентов без коморбидных заболеваний — 1,1±0,8. Послеоперационные соматические осложнения развились в 57 случаях (19,7%), из них в группе коморбидных — у 22 человек (23,9%). Умерло 32 больных (11,1%). Кардиопульмональные осложнения возникли у всех 12 умерших пациентов с коморбидностью, у 6 они стали основной причиной смерти. Из 20 умерших некоморбидных пациентов соматические осложнения были зарегистрированы у 15 (75%), причиной смерти они стали у 6 (30%). Индекс Чарлсона у умерших коморбидной группы был 2,0±1,2, среди пациентов без коморбидног7нннннннн67гсти — 1,4±1,1 (р=0,01). Логистический анализ показал, что наличие коморбидности и индекс Чарлсона значимо влияли на исход заболевания (р=0,02) с отношением шансов 0,6 и на возникновение осложнений (р=0,04) — 0,9 и 0,7 соответственно. Отношение шансов наступления летального исхода равнялось 0,96 при наличии сердечно-сосудистой патологии, 0,3 — при легочной патологии и 0,04 — при наличии гепатита (р=0,0006), развития послеоперационных осложнений — 0,85; 0,64 и 0,09 соответственно (р=0,02). При развитии легочных осложнений отношение шансов наступления летального исхода составило 0,02, сердечно-сосудистых — 0,09 (р=0,0001). Прогностический нутритивный индекс не показал различий между группами.

Заключение

Заключение. Коморбидная патология имелась у трети пациентов, которым была выполнена эзофагопластика. Кардиопульмональные осложнения служат причиной смерти у половины умерших пациентов с коморбидной патологией. Коморбидность и индекс Чарлсона — чувствительные и объективные предикторы неблагоприятного исхода после эзофагопластики.

The purpose of the study was to assess the impact of comorbidity on esophagoplasty outcomes.

Materials and methods

Materials and methods. The outcomes of 289 patients undergoing esophagoplasty for cancer (251) and benign diseases of the esophagus (48) were analyzed, the comorbidity, Charlson index and prognostic nutritional index were calculated.

Results

Results. Comorbid diseases were detected in 92 patients (31.8%), the Charlson index in this group was 2.4±1.1. In the group without comorbidity it was 1.1±0.8. Postoperative somatic complications developed in 57 cases (19.7%), in comorbid-ity group — 22 patients (23.9%), without comorbidity — 35 people (17.8%). 32 patients died (11.1%). Cardiopulmonary complications occurred in all 12 fatal outcomes in comorbid patients, in half of them they became the main cause of death.

Somatic complications were in 15 (75%) of 20 fatal outcomes in patients without comorbidity, they became the cause of death in 6 (30%). The Charlson index in comorbid group was 2.0±1.2 versus 1.4±1.1 in the other patients (p=0.01). The presence of comorbidity and the Charlson index significantly infl uenced the outcome of the disease (p=0.02) with logistic probability of 0.6 and a smaller logit spread, as well as the occurrence of complications in the postoperative period (p = 0.04) with values of 0.9 and 0.7, respectively. The logistic probability of a fatal outcome was 0.96 in cardiovascular pathology, 0.3 in pulmonary pathology, and 0.04 in hepatitis (p = 0.0006). The logistic probability of postoperative complications in cardiovascular pathology was 0.85, in pulmonary pathology — 0.64, in hepatitis — 0.09 (p = 0.02). The logistic probability of a fatal outcome with the development of pulmonary complications was 0.02, cardiovascular complications — 0.09 (p = 0.0001). The Onodera’s prognostic nutritional index in comorbid patients was 43±9, in others — 44±4 (p = 0.5).

Conclusion

Conclusion: comorbidity was detected in one third of patients who underwent esophagoplasty. Cardiopulmonary complications cause death in half of the deceased patients with comorbidity. The Charlson Index proved to be the most sensitive and objective predictor of outcomes in patients with comorbid diseases.

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The authors declare that there are no conflicts of interest present.