完全腹腔镜远端胃癌根治术中及术后吻合口漏的危险因素分析  

Risk factors analysis of intraoperative and postoperative anastomotic leakage in totally laparoscopic radical distal gastrectomy

作　　者：邓春 张伟[2] 吴兴康 赵旭 李小军[2] DENG Chun;ZHANG Wei;WU Xing-kang;ZHAO Xu;LI Xiao-jun(Graduate Department,Xi’an Medical University,Xi’an Shaanxi 710021,China;Department of General Surgery,Shaanxi Provincial People’s Hospital,Xi’an Shaanxi 710068,China)

机构地区：[1]西安医学院研究生处,陕西西安710021 [2]陕西省人民医院普外科,陕西西安710068

出　　处：《局解手术学杂志》2021年第11期956-960,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：陕西省科学技术研究发展计划项目(2014K11-02-01-02)。

摘　　要：目的探讨完全腹腔镜远端胃癌根治术中及术后吻合口漏的危险因素。方法回顾性分析462例行完全腹腔镜远端胃癌根治术患者的临床资料,根据术中亚甲蓝检查和术后影像学及内镜检查结果,收集术中吻合口漏和术后吻合口漏患者的病历资料,采用Logistic回归模型分析发生术中吻合口漏及术后吻合口漏的危险因素。结果462例患者中6例(1.3%)出现术中吻合口漏,经缝合加强后,未出现术后吻合口漏;BMI≥25 kg/m^(2)、手术时间≥4 h及新辅助化疗是出现术中吻合口漏的独立危险因素(P<0.05)。4例(0.9%)未出现术中吻合口漏的患者出现术后吻合口漏;年龄≥75岁、BMI≥25 kg/m^(2)是发生术后吻合口漏的独立危险因素(P<0.05)。结论BMI≥25 kg/m^(2)、手术时间≥4 h及新辅助化疗是出现术中吻合口漏的独立危险因素,年龄≥75岁、BMI≥25 kg/m^(2)是出现术后吻合口漏的独立危险因素,临床应重点关注有以上特征的患者,术中应进行亚甲蓝检查以避免术中吻合技术缺陷,术后应密切关注吻合口情况,及时对症处理。Objective To investigate the risk factors of intraoperative and postoperative anastomotic leakage in totally laparoscopic radical distal gastrectomy.Methods The clinical data of 462 patients who underwent totally laparoscopic radical distal gastrectomy were retrospectively analyzed,the medical records of patients with intraoperative anastomotic leakage and postoperative anastomotic leakage were collected according to the results of intraoperative methylene blue examination,postoperative imaging and endoscopy.The Logistic regression model was used to analyze the risk factors of intraoperative anastomotic leakage and postoperative anastomotic leakage.Results Among the 462 patients,6 patients(1.3%)had intraoperative anastomotic leakage,but none developed postoperative anastomotic leakage after intraoperative suture reinforcement.BMI≥25 kg/m^(2),operation time>4 hours and neoadjuvant chemotherapy were the independent risk factors of intraoperative anastomotic leak.Four patients(0.9%)without intraoperative anastomotic leakage developed postoperative anastomotic leak,and age≥75 years old and BMI≥25 kg/m^(2) were the independent risk factors of postoperative anastomotic leakage.ConclusionBMI≥25 kg/m^(2),operation time≥4 hours and neoadjuvant chemotherapy were the independent risk factors for intraoperative anastomotic leakage,age≥75 years old,BMI≥25 kg/m^(2) were the independent risk factors for postoperative anastomotic leakage.Attention should be paid for patients with the above characteristics,and methylene blue examination should be carried out to avoid intraoperative technical defects of anastomosis,close attention should be paid to the anastomotic condition after surgery and treat symptomatically in time.

关 键 词：吻合口漏 亚甲蓝 胃肿瘤 完全腹腔镜 远端胃癌根治术 

分 类 号：R735.2[医药卫生—肿瘤]