胃癌加速康复外科应用的影响因素分析  

Analysis of factors influencing the application of enhanced recovery after surgery in gastric cancer

作　　者：邵俊[1] 苏明琪[1] 周嘉[1] 王家亮 陈颖[2] 孙鹏[1] 张辉[1] Shao Jun;Su Mingqi;Zhou Jia;Wang Jialiang;Chen Ying;Sun Peng;Zhang Hui(Department of General Surgery;Department of Oncology,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China)

机构地区：[1]上海交通大学医学院附属同仁医院普外科,200336 [2]上海交通大学医学院附属同仁医院肿瘤科,200336

出　　处：《中华普通外科学文献（电子版）》2018年第5期319-323,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：上海市医学重点专科建设计划项目(ZK2015A25);上海市卫生和计划生育委员会面上项目(201640275)

摘　　要：目的应用二分类Logistics回归方法分析探讨胃癌加速康复外科应用的影响因素。方法回顾性分析2015年3月至2016年10月间上海交通大学医学院附属同仁医院行胃癌手术的108例患者术后快速恢复情况,通过二元Logitstic回归分析,寻找出影响胃癌患者术后快速康复的因素。结果回归分析显示术中行空肠造口、肿瘤TNM分期、行全胃或远端胃切除、术后排气时间、术后早期饮食为胃癌术后能否完成快速康复的影响因素,非标准化系数分别为5.813、-2.571、-0.944、1.332、-5.032,标准误分别为2.439、1.279、5.481、0.575、1.331,P值分别为0.017、0.044、0.049、0.021、0.000。Logistics回归模型建立通过显著性检验(χ2=99.96,P<0.01),模型有效率为89.8%。结论术中是否行空肠造口、胃癌的TNM分期、全胃或远端胃切除、术后排气时间和术后能否早期饮食可能为胃癌术后快速康复的影响因素,其中术中空肠造口、胃癌TNM分期较早,未行全胃切除、术后早期快速康复饮食、术后排气时间较早是促进因素,胃癌TNM分期较晚、术中行全胃切除则可能延缓快速康复。Objective To analyze the factors influencing the application of enhanced recovery after surgery（ERAS） in gastric cancer with the two classification logistics regression method. Methods A retrospective analysis of the recovery after gastric surgeries was carried out on one hundred and eight patients who suffered from gastric malignant tumor between March 2015 and October 2016, to find out the influencing factors on ERAS for gastric cancer. Results The regression analysis showed that jejunostomy, TNM staging, total gastric or distal gastrectomy, postoperative exhaust time and early postoperative diet were factors influencing the rapid rehabilitation after gastric cancer surgery; the non standardized coefficiency were 5.813,-2.571,-0.944, 1.332,-5.032, the standard errors were 2.439, 1.279, 5.481, 0.575, 1.331, and P values were 0.017, 0.044, 0.049, 0.021, 0.000, respectively. Logistics regression model was established by significance test（χ2=99.96, P〈0.01）, and the effective rate of the model was 89.8%. Conclusions Whether jejunostomy is performed during the operation, TNM staging of gastric cancer, total gastric or distal gastrectomy, postoperative exhaust time and early diet may be the factors affecting the rapid recovery of gastric cancer after operation, in which intraoperative jejunostomy, early TNM staging, without total gastrectomy, postoperative early stage fast rehabilitation diet, and postoperative exhaust time are the promotion factors. Late TNM stage of gastric cancer and total gastrectomy during operation may delay rapid recovery.

关 键 词：胃肿瘤 加速康复外科 LOGISTIC模型 因素分析 统计学 

分 类 号：R735.2[医药卫生—肿瘤]