腹腔镜胃癌根治术后早期腹腔出血的危险因素分析  

Risk factors of early abdominal hemorrhage after laparoscopic radical gastrectomy for gastric cancer

作　　者：劳锡锋 张志平[2] 杨佳宾 严志龙[2] LAO Xifeng;ZHANG Zhiping;YANG Jiabin;YAN Zhilong(Medical College of Ningbo University,Ningbo 315300,China)

机构地区：[1]宁波大学医学院,315000 [2]宁波市第一医院胃肠外科

出　　处：《浙江医学》2021年第11期1201-1204,1216,共5页Zhejiang Medical Journal

基　　金：浙江省科技厅公益技术应用研究项目(LGF19H030007)。

摘　　要：目的探讨腹腔镜胃癌根治术后早期腹腔出血的危险因素。方法选取2018年9月至2020年6月宁波市第一医院胃肠外科收治的行腹腔镜胃癌根治术患者446例。采用单因素、多因素logistic回归分析腹腔镜胃癌根治术后腹腔出血的独立危险因素。结果446例患者术后发生腹腔出血9例,占2.0%。其中3例为腹腔内血管夹脱落或血管裂开后血管残端渗血,行腹腔镜探查后加固残端血管;1例为Trocar孔出血,予腹腔镜下疝钩针全层缝合;5例为操作面渗血,出血量少,因此予保守治疗;9例患者术后均恢复正常出院。术后出血组(9例)和术后未出血组(437例)的临床病理资料单因素分析结果显示,两组患者性别、年龄、肿瘤部位、肿瘤分化程度、TNM分期、吻合方式、有无糖尿病和高血压、术前PT、术前和术后APTT、术前Fib、术前和术后Hb比较差异均无统计学意义(均P>0.05);而两组BMI、术后PT、Fib及淋巴结清扫数比较差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,BMI、术后PT及淋巴结清扫数为腹腔镜胃癌根治术后腹腔出血的独立危险因素(均P<0.05)。结论影响腹腔镜胃癌根治术后早期腹腔出血的独立危险因素为BMI、术后PT及淋巴结清扫数。Objective To explore the risk factors of early abdominal bleeding after laparoscopic radical gastrectomy for gastric cancer.Methods The clinical data of 446 patients with gastric cancer who underwent laparoscopic radical gastrectomy in the Department of Gastrointestinal Surgery of Ningbo First Hospital from September 2018 to June 2020 were analyzed retrospectively.Chi-square test,univariate and multivariate Logistic regression analyses were performed for analysis.Results Among 446 patients with gastric cancer,postoperative abdominal hemorrhage occurred in 9 cases(2.0%),and there was no perioperative death.Univariate analysis showed that BMI,Fib and the number of lymph node dissected were related to postoperative abdominal bleeding(P<0.05).The postoperative PT in the bleeding group was significantly lower than that in the non-bleeding group(P<0.05).Multivariate analysis showed that BMI(95%CI:0.001-0.608,P=0.024)and postoperative PT(95%CI:0.000-0.415,P=0.016)were protective factors and the number of lymph node dissected(95%CI:1.147-2.333,P=0.007)was the independent risk factor of early abdominal bleeding after laparoscopic radical gastrectomy.Conclusion The factors related to early abdominal bleeding after laparoscopic radical gastrectomy are BMI,postoperative PT and the number of lymph node dissected.

关 键 词：胃肿瘤 腹腔镜 胃癌根治术 术后腹腔出血 

分 类 号：R735.2[医药卫生—肿瘤]