老年胃癌患者全胃切除术后肠梗阻发生的危险因素分析:病例对照研究  

Risk factors affecting postoperative ileus after total gastrectomy in elderly patients with gastric cancer

作　　者：师帅 冯涛 高德健 伍晓晶 武曦 张香丽[2] SHI Shuai;FENG Tao;GAO Dejian;WU Xiaojing;WU Xi;ZHANG Xiangli(The Second Department of General Surgery,Shaanxi Provincial People’s Hospital,Xi’an 710068,P.R.China;Critical Care Medicine Union,Shaanxi Provincial People’s Hospital,Xi’an 710068,P.R.China)

机构地区：[1]陕西省人民医院普外二科,西安710068 [2]陕西省人民医院重症医学科,西安710068

出　　处：《中国普外基础与临床杂志》2024年第1期69-73,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的分析影响老年(年龄≥60岁)胃癌患者全胃切除术后肠梗阻发生的危险因素。方法回顾性收集2015年1月至2020年12月期间陕西省人民医院普外科收治的行全胃切除术后胃癌患者,了解其术后肠梗阻发生情况,同时采用单因素和多因素logtistic回归分析方法了解老年胃癌患者全胃切除术后肠梗阻发生的危险因素。结果本研究共收集到符合本研究条件的306例老年胃癌患者,其中有33例(10.8%)患者术后发生了肠梗阻,多因素logtistic回归分析结果显示,术前存在贫血[OR(95%CI)=2.740(1.181,6.356),P=0.019]、术前合并肠梗阻[OR(95%CI)=3.286(1.208,8.935),P=0.020]、采用开腹手术[OR(95%CI)=3.753(1.298,10.848),P=0.015]、手术时间≥400 min[OR(95%CI)=3.902(1.705,8.925),P=0.001]的老年胃癌患者行全胃切除术后发生肠梗阻的概率增高。结论从本研究分析结果发现,术前存在贫血及合并肠梗阻以及采用开腹手术和手术时间≥400 min增加老年胃癌患者行全胃切除术后发生肠梗阻的风险,对老年胃癌患者在选择行全胃切除时需调整其术前身体状态如纠正贫血、解除术前肠梗阻,术中根据老年患者的个体条件酌情选择微创手术,并且提高手术医师的手术操作技术,从而减少术后肠梗阻的发生。Objective To analyze the risk factors affecting the postoperative ileus after total gastrectomy in elderly patients with gastric cancer.Methods The elderly patients with gastric cancer after total gastrectomy admitted to the Second Department of General Surgery of Shaanxi Provincial People’s Hospital from January 2015 to December 2020 were retrospectively collected and the postoperative ileus was analyzed.Meanwhile the risk factors affecting the postoperative ileus after total gastrectomy in the elderly patients with gastric cancer were analyzed using univariate and multivariate logtistic regression analyses.Results A total of 306 elderly patients with gastric cancer who met the inclusion and exclusion criteria of this study were collected,33(10.8%)of whom suffered the postoperative ileus after surgery.The results of multivariate logtistic regression analysis showed that the preoperative anemia[OR(95%CI)=2.740(1.181,6.356),P=0.019],preoperative complicated intestinal obstruction[OR(95%CI)=3.286(1.208,8.935),P=0.020],open operation[OR(95%CI)=3.753(1.298,10.848),P=0.015],and operative time≥400 min[OR(95%CI)=3.902(1.705,8.925),P=0.001]increased the risk probability of postoperative ileus after total gastrectomy in the elderly patients with gastric cancer.Conclusions According to the analysis results of this study,the preoperative anemia and complicated intestinal obstruction,as well as the adopted open surgery and operation time≥400 min are the risk factors of postoperative ileus in elderly patients with gastric cancer after total gastrectomy.When total gastrectomy is chosen for elderly patients with gastric cancer,preoperative physical status needs to be adjusted,such as correcting anemia and removing preoperative intestinal obstruction.During operation,the operation modus should be prior to the minimally invasive surgery according to the individual conditions of elderly patients and the operation skills of surgeons should be improved so as to reduce postoperative ileus.

关 键 词：老年 胃癌 全胃切除术 术后肠梗阻 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]