腹腔镜胃癌根治性全胃切除术后外科并发症的Clavien-Dindo分级及危险因素分析  

Risk Factors Analysis and Clavien-Dindo Classification of Surgical Complications After Laparoscopic Total Gastrectomy for Gastric Cancer

作　　者：陈秋贤[1] 蔡丽生[1] 方顺勇[1] 沈俊涛[1] 连明桥 蔡铭智[1] 洪建明[1] 

机构地区：[1]福建医科大学附属漳州市医院普外二科,漳州363000

出　　处：《中国微创外科杂志》2017年第2期120-125,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：福建省医学创新课题(项目编号:2014-CXB-29)

摘　　要：目的探讨腹腔镜胃癌根治性全胃切除术后外科并发症的Clavien-Dindo分级情况及危险因素。方法回顾性分析2008年1月~2015年12月我院281例胃中上部癌行腹腔镜根治性全胃切除术的临床资料,根据Clavien-Dindo分级系统分析术后外科并发症的发生情况,并采用logistic回归分析术后外科并发症发生的危险因素。结果发生外科并发症29例,发生率10.3%(29/281),其中严重外科并发症9例,发生率3.2%(9/281)。术后外科并发症的Clavien-Dindo分级情况:Ⅰ级3例(1.1%),Ⅱ级17例(6.0%),Ⅲa级4例(1.4%),Ⅲb级2例(0.7%),Ⅳ级2例(0.7%),Ⅴ级1例(0.4%)。单因素分析结果显示患者年龄、BMI、手术时间、术中出血量、肿瘤分化、肿瘤大小、浸润深度有统计学差异(P<0.05)。logistic多因素分析表明年龄(OR=2.671,95%CI:1.138~6.269,P=0.024)、BMI(OR=4.970,95%CI:1.597~15.465,P=0.006)、肿瘤大小(OR=3.311,95%CI:1.068~10.260,P=0.038)、浸润深度(OR=4.472,95%CI:1.120~17.862,P=0.034)和术中出血量(OR=3.835,95%CI:1.481~9.928,P=0.006)是腹腔镜胃癌根治性全胃切除术后外科并发症发生的独立危险因素。多因素logistic回归模型预测患者术后外科并发症发生的受试者工作特征(reciever operating characteristic,ROC)曲线下面积是0.784(0.695~0.873)。结论腹腔镜胃癌根治性全胃切除术后外科并发症的Clavien-Dindo分级以Ⅱ级较多见;患者年龄≥65岁、BMI≥25、肿瘤大小≥50 mm、浸润深度≥T3及术中出血量≥100 ml应警惕外科并发症的发生。Objective To investigate risk factors and Clavien-Dindo classification of surgical complications after laparoscopic total gastrectomy（ LTG）. Methods Clinical data of 281 patients who underwent LTG for middle or upper gastric cancer in our hospital from January 2008 to December 2015 were collected. The surgical complications after LAG were analyzed according to the Clavien-Dindo classification,and risk factors of the postoperative surgical complications were evaluated by using the logistic regression model. Results Of the 281 patients,29（ 10. 3%） had postoperative surgical complications,and 9（ 3. 2%） developed major surgical complications. According to the Clavien-Dindo classification of postoperative surgical complications,3 patients（ 1. 1%） were detected in grade Ⅰ,17（ 6. 0%） in grade Ⅱ,4（ 1. 4%） in grade Ⅲa,2（ 0. 7%） in grade Ⅲb,2（ 0. 7%） in grade Ⅳ and 1（ 0. 4%） in grade Ⅴ. The univariable analysis showed that age,BMI,operative time,intraoperative blood loss,tumor size,tumor grade and depth of tumor invasion were associated with an increased risk of surgical complications after LTG. A multivariate analysis showed that age（ OR = 2. 671,95% CI： 1. 138- 6. 269,P = 0. 024）,BMI（ OR = 4. 970,95% CI： 1. 597- 15. 465,P = 0. 006）,tumor size（ OR = 3. 311,95% CI： 1. 068- 10. 260,P = 0. 038）,depth of tumor invasion（ OR = 4. 472,95% CI： 1. 120- 17. 862,P = 0. 034） and intraoperative blood loss（ OR = 3. 835,95% CI： 1. 481- 9. 928,P = 0. 006） were identified as independent risk factors for postoperative surgical complications. The area under the ROC curve was 0. 784（ 0. 695- 0. 873） for the logistic regression model for postoperative surgical complications. Conclusions Surgical complications after LTG are mainly in grade Ⅱ of ClavienDindo classification. Age ≥65 years,BMI ≥25,tumor size ≥50 mm,depth of tumor invasion ≥T_3 and intraoperative blood loss ≥100 ml are independent risk factors for postoperative surgical complications.

关 键 词：胃癌 腹腔镜 全胃切除术 外科并发症 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]