术前伴发疾病对腹腔镜辅助全胃切除术后腹部并发症的影响  

Impact of preoperative comorbidities on abdominal complications after laparoscope-assisted total gastrec- tomy for gastric cancer

作　　者：王家镔[1] 郑朝辉[1] 李平[1] 谢建伟[1] 林建贤[1] 陆俊[1] 陈起跃[1] 曹龙龙[1] 林密[1] 黄昌明[1] 

机构地区：[1]福建医科大学附属协和医院胃外科,福州350001

出　　处：《中华消化外科杂志》2017年第3期275-280,共6页Chinese Journal of Digestive Surgery

基　　金：福建省科技创新联合资金项目（2016Y9031）

摘　　要：目的探讨术前伴发疾病对腹腔镜辅助全胃切除术（LATG）术后腹部并发症的影响。方法采用回顾性病例对照研究方法。收集2008年1月至2015年12月福建医科大学附属协和医院收治的1657例行LATG胃癌患者的临床资料。术后175例患者发生腹部并发症，其中78例无术前伴发疾病，97例有术前伴发疾病（疾病种类为1种52例、2种30例、≥3种15例）。分析方法和观察指标：（1）行LATG胃癌患者术后发生腹部并发症的危险因素分析。（2）行LATG胃癌患者术后发生腹部并发症的风险评估：以（1）中独立影响因素为因变量，建立列线图，计算一致性指数。（3）不同术前伴发疾病种类患者行LATG术后腹部并发症发生情况比较。（4）有术前伴发疾病行LATG胃癌患者术后发生腹部并发症的多因素分析。（5）随访情况。采用门诊和电话方式进行随访，了解患者术后生存情况。随访时间截至2016年5月。单因素分析和计数资料比较采用x。检验，多因素分析采用Logistic回归模型。采用Kaplan—Meier法计算生存率。结果（1）行LATG胃癌患者术后发生腹部并发症的危险因素分析：单因素分析结果显示：年龄、BMI、术前伴发疾病种类、手术时间、术中估计出血量是影响行LATG胃癌患者术后发生腹部并发症的相关因素（x^2=4．487，16．602，10．361，4．567，7．482，P〈0．05）。多因素分析结果显示：BMI、术前伴发疾病种类、术中估计出血量是影响行LATG胃癌患者术后发生腹部并发症的独立因素（OR=1．966，1．204，1．423．95％可信区间：1．355～2．851，I．014～1．431，1．013～1．999，P〈0．05）。（2）行LATG胃癌患者术后发生腹部并发症的风险评估：以BMI、术前伴发疾病种类、术中估计出血量为因变量，建立预测行LATG胃癌患者术后发生腹部并发症风险的列线图；其一致性指数为0．703。（3）不同Objective To investigate the impact of preoperative comorbidities on the abdominal complica- tions after laparoscope-assisted total gastrectomy （LATG） for gastric cancer. Methods The retrospective case- control study was conducted. The clinical data of 1 657 gastric cancer patients who underwent LATG at the Fujian Medical University Union Hospital between January 2008 and December 2015 were collected. There were 175 patients with postoperative abdominal complications, including 78 without preoperative comorbidities and 97 with preoperative comorbidities （52 with 1 eomorbidity, 30 with 2 comorbidities and 15 with more than 3 comor- bidities）. Analysis method and observation indicators ： （ 1 ） risk factors analysis of abdominal complications after LATG ; （2） risk assessment of abdominal complications after LATG ： independent influencing factors of risk factors analysis were expressed as dependent variables, alignment diagram was built and then consistency index was calculated ; （3） comparisons of abdominal complications among the patients with different kinds of comorbidities after LATG; （4） multivariate analysis of abdominal complications in patients with comorbidities after LATG; （5） follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to May 2016. The univariate analysis and muhivariate analysis were respectively done using the chi-square test and Logistic regression model. The survival rate was calculated by the Kaplan-Meicr method. Results （ 1 ） Risk factors analysis of abdominal complications after LATG： results of univariate analysis showed that age, body mass index （ BMI）, number of preoperative comorbidities, operation time and estimated volume of intraoperative blood loss were related factors affecting abdominal complications of patients after LATG （X^2 = 4. 487, 16. 602, 10. 361, 4. 567, 7.482, P〈0. 05）. Results of multivariate analysis showed that BMI, number of p

关 键 词：胃肿瘤 胃切除术 伴发疾病 术前 并发症 腹部 腹腔镜检查 

分 类 号：R735.2[医药卫生—肿瘤]