Objective: To explore the related risk factors of diaphragmatic hernia after thoraco-laparoscopic minimally invasive Mckeown esophagectomy (MIME). Methods: This is a retrospective controlled study. A retrospective analysis was conducted on the clinical data of patients who underwent MIME at the Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, from January 2016 to December 2023. A total of 619 patients were included. There were 423 males and 196 females, aged (63.7±7.6) years (range: 37 to 87 years). The diagnosis of diaphragmatic hernia after MIME was made based on clinical symptoms and CT scans. Patients were divided into two groups: the diaphragmatic hernia group (n=16) and the non-diaphragmatic hernia group (n=603). Clinical data, including age, gender, body mass index (BMI), smoking history, tumor location (upper, middle, and lower thoracic esophagus), preoperative neoadjuvant therapy history, and tumor staging, were collected and analyzed. A BMI of 25 kg/m² and age of 65 years were used as cutoff values. The χ² test and Fisher's exact test were used to compare the data between the two groups, and Logistic regression was employed for risk factor analysis. The diaphragmatic hernia group and non-diaphragmatic hernia group were matched in a 1∶3 ratio with a caliper value of 0.02 by propensity score matching. Kaplan-Meier method was used for survival analysis and compared using the log-rank test for between-group differences. Results: The proportion of patients with diaphragmatic hernia after MIME who underwent surgical treatment was 6/16. Statistically significant differences were observed between the diaphragmatic hernia group and the non-diaphragmatic hernia group in terms of age (χ²=16.057, P<0.01), BMI (χ²=16.057, P<0.01), and tumor location (χ²=12.048, P=0.002). Multivariate logistic regression analysis revealed that age ≥65 years (OR=1.236, P=0.023) and BMI<25 kg/m² (OR=0.810, P<0.01) were independent risk factors for the development of diaphragmatic hernia after MIME. Survival analysis showed no significant difference in long-term survival between patients with and without diaphragmatic hernia after MIME (P=0.187), and whether patients with diaphragmatic hernia underwent surgery was not associated with long-term prognosis (P=0.560). Conclusion: Patients with BMI<25 kg/m2 and age ≥65 years are independent risk factors for diaphragmatic hernia after MIME. The occurrence of diaphragmatic hernia is not associated with prognosis, and whether patients with diaphragmatic hernia undergo surgery does not affect the prognosis.
目的： 探讨胸腹腔镜联合微创Mckeown食管癌切除术（MIME）后发生膈疝的危险因素。 方法： 本研究为回顾性病例对照研究。回顾性分析2016年1月至2023年12月在河北医科大学第四医院胸外科接受MIME治疗的患者的临床资料。纳入619例患者，其中男性423例，女性196例，年龄（63.7±7.6）岁（范围：37~87岁）。通过临床症状和CT检查诊断患者MIME术后是否发生膈疝，并将患者分为膈疝组（n=16）和无膈疝组（n=603）。收集并分析患者的年龄（≥65岁或<65岁）、性别、体重指数（≥25 kg/m2或<25 kg/m2）、吸烟史、肿瘤位置（胸上段、胸中段、胸下段）、是否进行术前新辅助治疗、肿瘤分期等临床资料。采用χ2检验或Fisher确切概率法比较组间数据，采用Logistic回归分析进行多因素分析。采用倾向性评分匹配将膈疝组和无膈疝组按1∶3进行匹配，卡钳值为0.02，采用Kaplan-Meier法进行生存分析，并采用Log-rank检验比较组间差异。 结果： MIME术后发生膈疝的患者行手术治疗的比例为6/16。膈疝组与无膈疝组患者中，年龄（χ²=16.057，P<0.01）、体重指数（χ²=16.057，P<0.01）、肿瘤位置（χ²=12.048，P=0.002）的差异均有统计学意义。多因素Logistic回归分析显示，年龄≥65岁（OR=1.236，P=0.023）和体重指数<25 kg/m2（OR=0.810，P<0.01）是MIME术后发生膈疝的独立危险因素。生存分析显示，MIME术后发生膈疝与未发生膈疝的患者长期生存无差异（P=0.187），发生膈疝的患者是否接受手术与长期预后无关（P=0.560）。 结论： 年龄≥65岁和体重指数<25 kg/m2是MIME术后发生膈疝的独立危险因素，发生膈疝的患者是否接受手术治疗不影响长期预后。.