胃癌术后吻合口漏的影响因素分析  

Analysis of anastomotic leakage after curative gastrectomy for gastric cancer

作　　者：曾奕[1] 应敏刚[1] 魏晟宏[1] 叶再生[1] 肖军[1] 王益[1] 林振孟 陈路川[1] ZENG Yi;YING Mingang;WEI Shen-hong;YE Zai-sheng;XIAO Jun;WANG Yi;LIN Zhen-meng;CHEN Lu-chuan(Depart-ment of Gastrointestinal Surgery, Fujian Provincial Tumor Hospital, Fujian Province Key Laboratory of Tumor Biotherapy, Fujian Province Fuzhou 350014, China)

机构地区：[1]福建省肿瘤医院胃肠肿瘤外科福建省肿瘤生物治疗重点实验室,福建福州350014

出　　处：《消化肿瘤杂志（电子版）》2017年第4期243-247,共5页Journal of Digestive Oncology(Electronic Version)

基　　金：福建省科技厅自然科学基金项目(2017Y0022);福建省卫生厅青年课题(2014-2-8)

摘　　要：目的通过分析胃癌术后吻合口漏的发生情况,探讨胃癌术后吻合口漏的相关因素。方法采用回顾性研究方法,收集福建省肿瘤医院2010年1月至2015年1月收治的2070例胃癌患者的临床资料。比较腹腔镜与开腹行胃癌手术后吻合口漏发生情况,并分析影响吻合口漏发生的危险和保护因素。结果腹腔镜下胃癌手术810例(全胃切除术560例,远端胃切除术250例),开腹胃癌手术1260例(全胃切除术840例,远端胃切除420例)。术后吻合口漏总体发生率2.80%(58/2070),腹腔镜术后吻合口漏发生率为1.35%(11/810),开腹术后发生率为3.73%(47/1260),差异具有统计学意义(P=0.001)。多因素回归分析显示:联合脏器切除(B=3.549>0,OR=34.773>1,P=0.000)、糖尿病(B=1.338>0,OR=3.812>1,P=0.000)、术前低蛋白血症(B=0.654>0,OR=1.922>1,P=0.049)、术前新辅助化疗(B=0.694>0,OR=1.530>1,P=0.043)均为独立危险因素,而腹腔镜(B=-1.459<0,OR=0.233<1,P=0.000)为保护性因素。结论对于胃癌手术,腹腔镜手术吻合口漏发生率低于开腹手术,联合脏器切除、糖尿病、术前低蛋白血症、术前新辅助化疗是胃癌术后吻合口漏的高危因素,而腹腔镜手术为胃癌术后吻合口漏的保护性因素,合理应用腹腔镜及恰当处理有助于降低胃癌术后吻合口漏的发生和进展。Objective To investigate the correlative factors of anastomotic leakage after gastrectomy for gastric cancer. Methods Gastric cancer patients who underwent gastrectomy at Fujian Provincial Tumor Hospital from January 2010 to January 2015 were retrospectively identified. Incidences of anastomotic leakage in laparoscopic and open gastrectomy were compared. The associations between anastomotic leakage and other various clinical characteristics were also analyzed. Results In total, 2,070 patients were included in this study. There were 810 cases received laparoscopic gastrectomy, among which 560 were total gastrectomy and250 were distal gastrectomy. The other 1,260 patients underwent open gastrectomy, with 840 total gastrectomy and 420 distal gastrectomy. The total incidence of anastomotic leakage was 2.80%(58/2070),with 1.35%(11/810) after laparoscopic surgeryand 3.73%(47/1260) after open surgery(P=0.001). Multivariate analysis showed that multivisceral resection(B=3.549, OR=34.773, P=0.000), diabetes(B=1.338, OR =3.81,P=0.000), preoperative hypoalbuminemia(B=0.654, OR=1.922, P=0.049), neoadjuvant chemotherapy(B=0.694, OR =1.530, P =0.043)were independent risk factors for the occurrence of anastomotic leakage after gastrectomy, whereas laparoscopic gastrectomy(B=-1.459, OR=0.233, P=0.000) was the only independent protective factor. Conclusions The incidence of anastomotic leakage after laparoscopic gastrectomy seems to be lower compared to open gastrectomy. Multivisceral resection, diabetes, preoperative hypoalbuminemia,neoadjuvant chemotherapy were independent risk factors for anastomotic leakage, while laparoscopic gastrec-tomy was the only protective factor. Rational application of laparoscopic gastrectomy would reduce the occurrence of anastomotic leakage after surgery, as appropriate management may help control its progress.

关 键 词：腹腔镜胃切除术 胃癌 吻合口漏 

分 类 号：R735.2[医药卫生—肿瘤]