胃癌患者全胃切除术后吻合口瘘的危险因素及其预后  

Risk factors and prognostic value of anastomotic leak in gastric cancer patients undergoing total gastrectomy

作　　者：林振孟 郑辉哲[1] 严明芳 卓长华[1] 李阳明[1] Lin Zhenmeng;Zheng Huizhe;Yan Mingfang;Zhuo Changhua;Li Yangming(Department of General Surgery,Fujian Medical University Cancer Hospital,Fuzhou 350014,China)

机构地区：[1]福建医科大学附属肿瘤医院胃肠肿瘤外科,福州350014

出　　处：《中华普通外科杂志》2018年第10期817-820,共4页Chinese Journal of General Surgery

基　　金：福建省卫生计生科研人员培养资助项目（2017-1-13）

摘　　要：目的研究全胃切除术后吻合口瘘的高危因素及其对胃癌患者预后的影响。方法回顾性分析1999-2016年福建医科大学附属肿瘤医院普外科胃癌患者术后发生吻合口瘘的高危因素。结果1547例胃癌患者中106例术后出现吻合口瘘，平均术后第（6．0±2．1）天发生吻合口瘘。非吻合口瘘组患者的平均住院时间少于吻合口瘘组[（9±3）d比（15±5）d，t=6．2，P=0．00]。单因素分析表明，吻合口瘘与患者的年龄、肺功能、BMI、血清白蛋白水平、术中出血量、手术时间、吸烟及糖尿病均有关（均P〈0．05）。多因素分析表明，吻合口瘘与患者的糖尿病、肺功能、吸烟均有关（均P〈0．05）。非吻合口瘘组患者30d内死亡率低于吻合口瘘组。吻合口瘘组患者的3年和5年生存率分别为53．9％和47．7％，低于非吻合口瘘组的69．4％和58．5％（P〈0．05）。单因素分析表明，BMI、病理分期、肿瘤大小、血清白蛋白、吻合口瘘与患者的预后均有关（均P〈0．05）。多因素分析表明，吻合口瘘是影响胃癌患者预后的独立危险因素。结论根治性全胃切除术后吻合口瘘不仅使胃癌患者术后30d死亡率升高，而且术后5年生存率也降低。Objective To analyze the risk factors for anastomotic leak after total gastrectomy in gastric cancer patients and its impact on patients survival. Methods A total of 1 547 gastric cancer patients who underwent curative resection between 1999 to 2016 were enrolled. Results The anastomotic leak occurred in 106 of 1 547 patients ; and it was happened at a median of （6.0 ± 2. 1 ） day after surgery. The median postoperative hospital stay was （9 ± 3） days for non-anastomotic leak, lower than patients for anastomotic leak with （15 ± 5 ）days. The anastomotic leak was significantly correlated with age, lung function, BMI, serum albumin, intraoperative blood loss, operative time, smoking and diabetes （P〈0. 05）. Muhivariable analysis showed that the anastomotic leak was significantly correlated with diabetes, lung function, smoking （P〈0.05）. The 30-day mortality with anastomotic leak was lower than patients without leak. The 3＇- and 5-year survival rate of patients with anastomotic leak were 53.9% and 47.7% , significantly lower than those of 69.4% and 58.5% without anastomotic leak （P〈0.05）. By univariate analysis that BMI, pathological stage, tumor size, serum albumin, anastomotic leak were factors affecting prognosis （P〈0.05 ） . While multivariate analysis showed that anastomotic leakage was independently associated with worse overall survival. Conclusion Anastomotic leakage in patients who underwent total gastrectomy increases the 30-day mortality and associated with poorer 5-year survival.

关 键 词：胃肿瘤 吻合口瘘 胃切除术 危险因素 预后 

分 类 号：R735.2[医药卫生—肿瘤]