医学临床研究
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医学临床研究  2021, Vol. 38 Issue (9): 1300-1303    DOI: 10.3969/j.issn.1671-7171.2021.09.006
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胃癌患者行腹腔镜辅助胃癌根治术的疗效及术后并发症发生的危险因素分析
于智慧, 韦昊汝
山东省立第三医院,山东 济南 250031
Effect of Laparoscopic Assisted Radical Gastrectomy on Gastric Cancer and Risk Factors of Postoperative Complications
YU Zhi-hui, WEI Hao-ru
Shandong Provincial Third Hospital, Jinan Shandong, 250031, China
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摘要 【目的】分析胃癌患者行腹腔镜辅助胃癌根治术的疗效及术后并发症发生的危险因素。【方法】选择2013年1月至2018年1月本院收治的236例行腹腔镜辅助胃癌根治术的胃癌患者,按照日本临床肿瘤学组(JCOG)制定的相关胃癌术后并发症分级标准,将Ⅱ级及以上并发症定义为发生并发症,Ⅱ级以下定义为未发生并发症。分析患者腹腔镜辅助胃癌根治术后发生并发症的相关危险因素,随访并记录患者的生存、肿瘤复发或转移的情况。【结果】236例胃癌患者均成功完成腹腔镜辅助胃癌根治术,共计65例(27.5%)发生术后并发症,其中胃排空障碍14例,肠吻合口漏12例,肠梗阻10例,不明原因的发热7例,十二指肠残端瘘5例,肺部感染5例,胰瘘、胆瘘4例,贫血3例,腹腔出血2例,吻合口漏2例,下肢静脉血栓1例。单因素分析显示,腹腔镜辅助胃癌根治术后并发症与患者的年龄、高血压、糖尿病、消化道重建方式、手术时间和术中出血量/体重相关(P<0.05)。多因素分析显示,患者年龄大于60岁、高血压、糖尿病、Billroth Ⅱ式吻合术、手术时间大于180 min和术中出血量/体重 ≥5 mL/kg均为术后并发症的独立危险因素。随访结果显示,105例患者无瘤生存,40例患者有肿瘤复发和(或)转移,36例患者发生胃癌相关性死亡,2例患者因心脑血管疾病死亡,1例因意外死亡。【结论】腹腔镜辅助胃癌根治术治疗胃癌的疗效较好,患者年龄大于60岁,术前存在高血压、糖尿病基础疾病,手术时间长,术中出血多和Billroth Ⅱ式吻合术均为术后出现并发症的独立危险因素。
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于智慧
韦昊汝
关键词 胃肿瘤/外科学腹腔镜检查胃切除术治疗结果手术后并发症危险因素    
Abstract:【Objective】To analyze the efficacy of laparoscopic assisted radical gastrectomy for gastric cancer and the risk factors of postoperative complications. 【Methods】236 patients with gastric cancer who underwent laparoscopic radical gastrectomy in our hospital from January 2013 to January 2018 were selected. According to the classification standard of postoperative complications of gastric cancer formulated by the Japanese Clinical Oncology Group (JCOG), grade Ⅱ, the above complications were defined as complications, and grade II and below were defined as no complications. The related risk factors of complications after laparoscopic assisted radical gastrectomy were analyzed, and the survival, tumor recurrence or metastasis were followed up and recorded. 【Results】 236 patients with gastric cancer successfully completed laparoscopic assisted radical gastrectomy. A total of 65 cases (27.5%) had postoperative complications, including 14 cases of gastric emptying disorder, 12 cases of intestinal anastomotic leakage, 10 cases of intestinal obstruction, 7 cases of unexplained fever, 5 cases of duodenal stump fistula, 5 cases of pulmonary infection, 4 cases of pancreatic fistula and biliary fistula, 3 cases of anemia, 2 cases of abdominal bleeding and 2 cases of anastomotic leakage, Lower extremity venous thrombosis in 1 case. Univariate analysis showed that complications after laparoscopic assisted radical gastrectomy were associated with age, hypertension, diabetes, digestive tract reconstruction, operative time and intraoperative blood loss/body weight (P<0.05). Multivariate analysis showed that patients older than 60 years old, hypertension, diabetes, Billroth Ⅱ anastomosis, operation time longer than 180 min and intraoperative blood loss/body weight equal to 5 mL/kg were independent risk factors for postoperative complications. The follow-up results showed that 105 patients survived without tumor, 40 patients had tumor recurrence and/or metastasis, 36 patients died related to gastric cancer, 2 patients died of cardiovascular and cerebrovascular diseases and 1 died of accident. 【Conclusion】Laparoscopic assisted radical gastrectomy is effective in the treatment of gastric cancer. The age more than 60 years old, preoperative hypertension, diabetes underlying diseases, long operation time, bleeding during operation and Billroth Ⅱ anastomosis are independent risk factors for postoperative complications.
Key wordsStomach Neoplasms/SU    Laparoscopy    Gastrectomy    Treatment Outcome    Postoperative Complications    Risk Factors
收稿日期: 2020-10-16     
中图分类号:  R735.2  
引用本文:   
于智慧, 韦昊汝. 胃癌患者行腹腔镜辅助胃癌根治术的疗效及术后并发症发生的危险因素分析[J]. 医学临床研究, 2021, 38(9): 1300-1303.
YU Zhi-hui, WEI Hao-ru. Effect of Laparoscopic Assisted Radical Gastrectomy on Gastric Cancer and Risk Factors of Postoperative Complications. JOURNAL OF CLINICAL RESEARCH, 2021, 38(9): 1300-1303.
链接本文:  
http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2021.09.006     或     http://journal07.magtech.org.cn/yxlcyj/CN/Y2021/V38/I9/1300
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