术前胃底体积大小对胃癌根治术后胃瘫危险性的预测价值  

Predictive value of preoperative gastric fund volume on postoperative gastroparesis

作　　者：周世振 翁昊[1] 雷粟 梁海滨[1] 陈磊[1] 张文杰[1] 王雪峰[1] Zhou Shizhen;Weng Hao;Lei Su;Liang Haibin;Chen Lei;Zhang Wenjie;Wang Xuefeng(Department of General Surgery,Xinhua Hospital,Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200096,China)

机构地区：[1]上海交通大学医学院附属新华医院普外科,200096

出　　处：《中华普通外科杂志》2021年第4期272-276,共5页Chinese Journal of General Surgery

摘　　要：目的探讨胃癌患者术前胃底大小与术后胃瘫的关系,以及胃瘫高危患者的有效预防措施。方法回顾性分析2015—2016年在上海交通大学医学院附属新华医院行胃癌根治术276例患者的临床资料。采用CT测量胃底胃容积比值(FV/TV),ROC曲线分析评价预测性能,单因素和多因素分析胃瘫的预测因素。将样本量增加到304例患者,其FV/TV>19.4%,分析这些患者的不同手术方法及围手术期处理方式。采用χ2检验和Logistic回归分析预防胃瘫的保护因素。结果胃瘫组患者的FV/TV高于非胃瘫组[(25.7%±7.4%)比(17.8%±9.4%),t=-3.783,P<0.05],差异有统计学意义。FV/TV与胃瘫持续时间呈正相关(r=0.858,P<0.05)。ROC曲线分析选取截断值19.4%,预测灵敏度为76.2%,特异度为53.7%。304例FV/TV>19.4%的患者中胃瘫的发生率为9.2%。残胃<1/3和术后早期胃肠减压患者的胃瘫发生率下降,差异均有统计学意义(均P<0.05)。结论术前FV/TV能有效预测术后胃瘫的风险;小残留胃和术后早期胃肠减压是预防高危患者胃瘫的有效措施。Objective To study the relationship between gastric fundus size and postoperative gastroparesis and to find effective ways to prevent postoperative gastroparesis in high-risk patients.Methods We retrospectively reviewed the clinical data of 276 gastric cancer patients undergoing radical gastrectomy from 2015 to 2016.The gastric fundus volume/total gastric volume(FV/TV)ratio was measured by computed tomography(CT)and comparative study between the gastroparesis group and the non-gastroparesis group was carried out in terms of postoperative gastroparesis.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive performance.Single-factor and multiple-factor analyses were performed to filter clinically significant predictive factors of gastroparesis.Then,we increased the sample size to 304 patients whose FV/TV ratio was>19.4%.The different surgical methods and perioperative management of these patients were analysed.The chi-square test and logistic regression analysis were performed to identify effective independent factors for preventing gastroparesis.Results The FV/TV ratio in the gastroparesis group was significantly higher than that in the non-gastroparesis group(P<0.05).A cut-off value of 19.4%was selected by ROC curve analysis,at which the FV/TV ratio had a sensitivity of 76.2%and a specificity of 53.7%.In 304 patients in the second retrospective study,the incidence of gastroparesis was 9.2%.Gastroparesis was significantly reduced in patients with residual gastric size<1/3(P<0.05)and early postoperative gastrointestinal decompression(P<0.05).Conclusions The FV/TV ratio can effectively predict the risk of postoperative gastroparesis preoperatively.Small residual stomach and early postoperative gastrointestinal decompression are effective measures to prevent gastroparesis in high-risk patients.

关 键 词：胃肿瘤 胃排空 胃切除术 预测 

分 类 号：R735.2[医药卫生—肿瘤]