腹腔镜胃癌D2根治术后出血发生的危险因素分析  

Risk factors of bleeding after laparoscopic D2 radical gastrectomy for gastric cancer

作　　者：宗德宝 袁江涛[2] 高登有 刘勇峰[2] Zong Debao;Yuan Jiangtao;Gao Dengyou;Liu Yongfeng(General Surgery Department,Wuqi County People＇s Hospital,Shaanxi 717600,China)

机构地区：[1]陕西省吴起县人民医院普外科,717600 [2]延安大学附属医院普外科

出　　处：《山西医药杂志》2018年第16期1870-1873,共4页Shanxi Medical Journal

基　　金：陕西省科技厅社会发展攻关项目(2014K12-06)

摘　　要：目的调查与分析腹腔镜胃癌D2根治术后出血发生的危险因素。方法选取2014年7月至2017年2月在我院进行腹腔镜胃癌D2根治术的83例患者,记录术后出血发生、处理与预后情况,调查患者的临床资料,分析出血发生的危险因素。结果所有患者都顺利完成手术,术中无严重并发症发生,无中转开腹患者,切缘无肿瘤细胞残留。术后发生出血6例,发生率为7%。单因素分析显示血小板、白蛋白、手术时间、肿瘤直径、血红蛋白、切口长度等与术后出血显著相关(P<0.05)。Logistic回归分析结果显示,血小板、白蛋白、手术时间、血红蛋白是腹腔镜胃癌D2根治术后出血发生的独立危险因素(P<0.05)。3例患者经药物治疗止血成功,2例患者在胃镜下止血成功,1例患者介入治疗止血成功,术后住院时间为(16.4±2.5)d。随访1年,术后出血患者的存活率为83%。结论腹腔镜胃癌D2根治术后出血比较常见,血小板、白蛋白、手术时间、血红蛋白为主要的危险因素,要积极加强出血因素调查与术后对症处理,以改善患者预后。Objective To investigate and analyze the risk factors of bleeding after laparoscopic D2 radical gastrectomy for gastric cance.Methods From July 2014 to February 2017,83 patients who underwent laparoscopic D2 radical gastrectomy in our hospital were selected as research subjects.All patients were given laparoscopic D2 radical gastrectomy,and the occurrence,treatment and prognosis of postoperative bleeding were recorded,the clinical data of the patients were investigated,and the risk factors for bleeding were analyzed.ResultsAll the operations were completed successfully,there were no serious complications occurred during operation,no conversion to open surgery,and no residual tumor cells on the margin.There were 6 cases of bleeding after operation,the incidence were 7%.Univariate analysis showed that platelet,albumin,operative time,tumor diameter,hemoglobin and incision length were significantly associated with postoperative bleeding（P〈0.05）.The results of Logistic regression analysis showed that platelet,albumin,operation time and hemoglobin were independent risk factors of bleeding after laparoscopic D2 radical gastrectomy for gastric cancer（P〈0.05）.Three bleeding patients were successfully treated by drug therapy,2 bleeding patients were successfully treated by gastroscopy,1 bleeding patient was successfully treated by interventional therapy,and the postoperative hospitalization time were（16.4± 2.5）d.After 1 years of follow-up,the survival rate of postoperative bleeding patients was 83%.Conclusion The bleeding after laparoscopic D2 radical gastrectomy for gastric cancer is common,platelet,albumin,operation time and hemoglobin are the main risk factors.Bleeding factors and postoperative symptomatic treatment need to be investigated and strengthened to improve the prognosis of the patients.

关 键 词：腹腔镜 胃肿瘤 出血 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]