胃癌根治术后并发胆囊炎的危险因素分析  

Risk factors of cholecystitis after radical gastrectomy for gastric cancer

作　　者：郭团魁 杨利青[2] 刘云[1] 田庆刚[1] 王晓娜[3] 李斌[3] 侯亚超 刘洪敏[3] 梁寒[3] 

机构地区：[1]包头市第八医院普通外科,014440 [2]包头市第四医院消化科,014000 [3]国家肿瘤临床医学研究中心天津医科大学肿瘤医院胃部肿瘤科,300060

出　　处：《中华胃肠外科杂志》2016年第4期406-408,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨胃癌根治术后发生胆囊炎的危险因素。方法回顾性分析2013年3月至2015年3月天津医科大学肿瘤医院胃部肿瘤科行胃癌根治术治疗、且术前无胆囊疾病的553例患者的临床资料。通过单因素和多因素Logistic回归模型分析胃癌根治术后患者发生胆囊炎的危险因素。结果全组患者男360例，女193例，年龄中位数为60岁。均经病理证实为胃腺癌，淋巴结清扫数目均≥15枚／例。术后随访6月至2年，术后胆囊炎的发病率为33．1％（183／553），胆囊结石发病率为4．9％（27／553）；其中清扫No．12淋巴结术后胆囊炎的发病率为39．6％（89／225），清扫No．8a者为38．0％（151／397），清扫No．5者为38．O％（68／179），清扫No．7者为34．4％（138／402），清扫No．9者34．7％（136／392）。单因素分析结果显示，清扫No．8a（x2=15．530，P=0．000）和N0．12淋巴结（x2=7．157，P=0．007）以及手术方式（x2=7．427，P=0．024）与胃癌根治术后胆囊炎的发生有关。多因素Logistic回归分析结果显示，清扫N0．8a淋巴结是胃癌术后发生胆囊炎的独立危险因素（DR=2．016，95％CI：1．244～3．267，P=0．004）。结论胃癌根治术中行No．8a淋巴结清扫时，应注意保护迷走神经干及交感神经节，以降低术后胆囊炎的发生率。Objective To investigate the risk factor of cholecystitis after radical gastrectomy for gastric cancer. Methods Clinicpathological data of 553 gastric cancer patients with normal gallbladders undergoing radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital between March 2013 and Mm＇ch 2015 were analyzed retrospectively. Univariate and multivariate analysis were applied to evaluate factors influencing the cholecystitis after radical gastrectomy using log-rank and logistic regression model. Results There were 360 males and 193 females with a median age of 60 years. All patients were followed up from 6 months to 2 years. The incidence of cholecystitis after radical gastrectomy for gastric cancer was 33.1% （183/553）, while incidence of cholecystolithiasis was 4.9% （27/553）. In addition, the cholecystitis incidence of patients with No.12 lymph node cleaning was 39.6%（89/225）, while with No.8a lymph node cleaning was 38.0% （151/397）, with No.5 lymph node cleaning was 38.0% （68/179）, with No.7 lymph node cleaning was 34.4% （138/402）, with No.9 lymph node cleaning was 34.7% （136/392）. Univariate log-rank test indicated that the lymphadenectomy of No.8a （X2 = 15.530, P = 0.000）, No.12 group （X2= 7.157, P = 0.007） andsurgical methods （x2 =7.427, P = 0.024） were significantly associated with cholecystitis after radical gastrectomy. Multivariate analysis showed that the lymphadenectomy of No.8a was independent factor of cholecystitis after radical gastrectomy （OR = 2.016, 95% CI： 1.244 to 3.267, P = 0.004）. Conclusions Vagal nerve trunk and sympathetic ganglion should be protected carefully during No.8a lymphadenectomy in radical gastrectomy for gastric cancer, in order to reduce the incidence of postoperative choleeystitis.

关 键 词：胃肿瘤 胆囊炎 淋巴结清扫 危险因素 

分 类 号：R735.2[医药卫生—肿瘤] R575.61[医药卫生—临床医学]