| 摘要: |
| 目的 探讨胃癌根治术围手术期并发症的危险因素。方法 回顾性分析2016年1月至2018年12月于我院接受胃癌根治术的1 580例胃癌患者的临床病理资料。记录患者的人口学信息、术前临床资料、手术相关信息、术后病理资料和并发症发生情况，并对并发症进行Clavien-Dindo分级。采用Pearson χ2检验评估胃癌根治术患者围手术期并发症与临床病理特征的关系，采用多因素logistic回归分析探讨患者围手术期并发症的独立危险因素。结果 1 580例患者中134例（8.48%）发生围手术期并发症，其中吻合口问题最常见（44例，2.78%），包括吻合口漏34例（2.15%）、吻合口出血7例（0.44%）、吻合口狭窄3例（0.19%），其次为胰漏27例（1.71%）和乳糜漏19例（1.20%）。并发症Clavien-Dindo分级≥ Ⅲ a者17例（1.08%）。单因素分析结果显示，年龄≥ 70岁（P=0.012）、患有基础疾病（P<0.01）、术前预后营养指数<38（P=0.033）、切除范围（P=0.036）、吻合方式（P<0.01）、术中失血量≥ 300 mL（P<0.01）、淋巴结清扫数目<25个（P=0.026）均与胃癌患者围手术期发生并发症有关。多因素logistic回归分析结果显示，患有基础疾病（OR=1.964，95% CI：1.231~3.133，P=0.005）、术中失血量（OR=1.002，95% CI：1.001~1.003，P<0.01）是胃癌患者围手术期发生并发症的独立危险因素。结论 对于患有基础疾病、术中失血量较多的胃癌患者，术后需要密切关注围手术期的症状、体征，警惕并发症的发生。 |
| 关键词: 胃肿瘤 并发症 危险因素 围手术期 |
| DOI：10.16781/j.0258-879x.2020.03.0287 |
| 投稿时间：2020-01-06修订日期：2020-02-24 |
| 基金项目:国家科技重大专项重大新药创制项目（2017ZX09304030）. |
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| Risk factors of perioperative complications after radical gastrectomy for gastric cancer |
| YUAN Shi-jie△,ZHANG Xing-zhi△,LIU Zhao-rui,SHI Zheng,CAI Hui,YIN Kai* |
(Department of Gastrointestinal Surgery, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To explore the risk factors of perioperative complications of radical gastrectomy for gastric cancer. Methods A retrospective study was conducted on 1 580 patients with gastric cancer who underwent radical gastrectomy in our hospital from Jan. 2016 to Dec. 2018. The demographic information, preoperative clinical data, operative information, postoperative pathological data and complications of the patients were recorded, and the complications were graded by Clavien-Dindo grading. Pearson χ2 test was used to evaluate the relationship between the perioperative complications and clinicopathological characteristics. Multivariate logistic regression was used to analyze the independent risk factors of perioperative complications. Results Of the 1 580 patients, 134 (8.48%) had perioperative complications. Anastomotic complications are the most common complications (44 cases, 2.78%), including 34 cases (2.15%) of anastomotic leakage, 7 cases (0.44%) of anastomotic bleeding, and 3 cases (0.19%) of anastomotic stenosis, followed by pancreatic leakage (27 cases, 1.71%) and chylous leakage (19 cases, 1.20%). Seventeen patients (1.08%) had complications with ClavienDindo grade ≥ Ⅲa. Univariate analysis showed that age ≥ 70 years (P=0.012), underlying diseases (P<0.01), preoperative prognostic nutritional index<38 (P=0.033), extent of resection (P=0.036), reconstruction mode (P<0.01), intraoperative blood loss ≥ 300 mL (P<0.01) and number of removed lymph nodes<25 (P=0.026) were associated with perioperative complications in gastric cancer patients. Multivariate logistic regression analysis showed that underlying diseases (odds ratio[OR]=1.964, 95% confidence interval[CI] 1.231-3.133, P=0.005) and intraoperative blood loss (OR=1.002, 95% CI 1.001-1.003, P<0.01) were the independent risk factors of perioperative complications in gastric cancer patients. Conclusion In gastric cancer patients with underlying diseases and large intraoperative blood loss, it is necessary to pay attention to perioperative symptoms and signs to avoid the development of complications. |
| Key words: stomach neoplasms complications risk factors perioperative period |
