机器人及腹腔镜胃癌根治术后胰瘘发生的影响因素分析  

Influencing factors for postoperative pancreatic fistula after robotic and laparoscopic radical gastrectomy

作　　者：张小磊 江志伟 王刚[2] 潘华峰 王海锋 江晓晖[1] 吴金东[1] Zhang Xiaolei;Jiang Zhiwei;Wang Gang;Pan Huafeng;Wang Haifeng;Jiang Xiaohui;Wu Jindong(Department of Gastrointestinal Surgery,Affiliated Tumor Hospital,Nantong University,Jiangsu Nantong 226000,China;Department of General Surgery,Jiangsu Provincial Hospital of Chinese Medicine,Jiangsu Nanjing 210004,China)

机构地区：[1]南通大学附属肿瘤医院胃肠外科,江苏南通226000 [2]江苏省中医院普外科,江苏南京210004

出　　处：《腹部外科》2022年第6期408-412,共5页Journal of Abdominal Surgery

基　　金：国家自然科学基金(81500417);湖北陈孝平科技发展基金(CXPJJH121001-2021060);江苏省中医药科技发展重点项目(ZD201903);南通市科技计划指导性项目(JCZ20134)。

摘　　要：目的探讨机器人及腹腔镜胃癌根治术后胰瘘发生的影响因素。方法回顾性分析2018年6月至2022年6月江苏省中医院普外科共386例行胃癌根治术病人的临床资料。统计所有病人的年龄、性别、体质量指数、糖尿病史、高血压史、腹部手术史、新辅助治疗史、肿瘤位置、手术方式、切除范围、淋巴结清扫数目、术中出血量、总手术时间和肿瘤分期等,采用单因素分析和二元Logistic回归多因素分析胃癌术后胰瘘发生的影响因素。结果386例病人胃癌术后胰瘘发生率为16.6%(64/386),生化瘘的发生率为13.5%(52/386),B级瘘的发生率为3.1%(12/386),无C级瘘发生。单因素分析和二元Logistic回归多因素分析结果显示:体质量指数、新辅助治疗、手术方式、淋巴结清扫数目、总手术时间及肿瘤分期是胃癌术后胰瘘的独立影响因素。结论体质量指数高、有新辅助治疗史、肿瘤分期偏晚和手术时间长的病人,应警惕胃癌术后胰瘘的发生,采用机器人操作系统手术能够减少胃癌术后胰瘘的发生。Objective To explore the influencing factors for postoperative pancreatic fistula after robotic and laparoscopic radical gastrectomy.Methods From June 2018 to June 2022,clinical data were retrospectively reviewed for 386 patients undergoing radical gastrectomy.Age,gender,body mass index(BMI),diabetic history,history of hypertension,history of abdominal surgery,history of neoadjuvant therapy,tumor site,surgical approach,extent of resection,number of lymph node dissections,intraoperative blood loss,total operative duration and tumor stage were recorded.Univariate and binary Logistic regression multivariate analyses were employed for analyzing the influencing factors of pancreatic fistula after radical gastrectomy.Results The incidence rate of pancreatic fistula after radical gastrectomy was 16.6%(64/386).And the incidence rates of biochemical fistula,grade B pancreatic fistula and grade C pancreatic fistula were 13.5%(52/386)and 3.1%(12/386).Univariate analysis and binary Logistic regression multivariate analysis showed that BMI,neoadjuvant therapy,surgical approach,number of lymph node dissections,total operative duration and tumor stage were the independent influencing factors of pancreatic fistula after radical gastrectomy.Conclusion Patients with high BMI,history of neoadjuvant therapy,advanced tumor stage and prolonged surgery are more prone to the postoperative occurrence of pancreatic fistula after radical gastrectomy.It may be minimized with robotic operating system.

关 键 词：胃肿瘤 胃切除术 机器人手术 腹腔镜手术 胰瘘 影响因素 

分 类 号：R656.61[医药卫生—外科学]