远端胃大部切除术后短期并发症的Clavien-Dindo分级及危险因素分析  

Clavien-Dindo grading and risk factor analysis of short-term complications after distal gastrectomy

作　　者：孙伟[1] 张忠涛[1] Sun Wei;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普外科,北京100050

出　　处：《国际外科学杂志》2024年第1期22-27,F0004,共7页International Journal of Surgery

基　　金：国家消化系统疾病临床医学研究中心国家科技支撑计划课题(2015BAI13B09)。

摘　　要：目的探讨远端胃大部切除(DG)短期(术后30 d内)并发症的Clavien-Dindo(CD)分级情况及影响该分级的相关危险因素。方法回顾性分析2016年1月—2021年12月首都医科大学附属北京友谊医院经同一术者完成的230例行DG的胃癌患者的临床资料,其中男性159例(69.1%),女性71例(30.9%),年龄31~80岁,平均年龄(61.69±10.91)岁;平均体重指数(23.59±3.46)kg/m2;计数资料组间比较采用χ2检验或Fisher确切概率法,等级资料进行组间比较采用秩和检验。多因素分析采用逐步法Logistic回归。结果本研究中,共有30例(13.0%)患者出现CD-Ⅱ级及以上术后并发症,其中Ⅱ级20例(66.7%),Ⅲ级8例(26.7%),Ⅳ级2例(6.6%),在30例并发症的患者中,单纯吻合口瘘2例,吻合口出血2例,十二指肠残端漏3例,腹腔感染2例,肠梗阻6例,肺部感染5例,切口感染2例,胃排空延迟2例;肺部感染合并肺不张3例,吻合口瘘合并腹腔感染2例,肺部感染、腹腔感染合并肠梗阻1例。手术途径是DG术后并发症的独立危险因素(P<0.05),不同手术途径患者的术后并发症CD分级差异无统计学意义(P>0.05)。结论肺部感染、肠梗阻、腹腔感染和吻合口瘘是DG术后的主要并发症,导致并发症的独立危险因素为手术途径,但手术途径不影响并发症CD分级。Objectives To explore the Clavien-Dindo(CD)classfication of short-term(within 30 days postoperative)complications of distal major gastrectomy(DG)and the associated risk factors affecting this classification.Methods A retrospective analysis was conducted on the clinical data of 230 patients with gastric cancer who underwent DG completed by the same operator at Beijing Friendship Hospital,Capital Medical University from January 2016 to December 2021.There were 159 males(69.1%)and 71 females(30.9%),aged from 31 to 80 years,with an average age of(61.69±10.91)years,all patients average body mass index was(23.59±3.46)kg/m2.Chi-square test or Fisher exact probability method was used to compare the count data between groups,and rank sum test was used to compare the rank data between groups.Multiple factors were analyzed by stepwise Logistic regression.Results In this study,a total of 30 cases(13.0%)experienced CD gradeⅡor higher postoperative complications.Among them,20 cases(66.7%)were gradeⅡ,8 cases(26.7%)were gradeⅢ,and 2 cases(6.6%)were gradeⅣ,Among the 30 patients with complications,there were 2 cases of simple anastomotic leakage,2 cases of anastomotic bleeding,3 cases of duodenal stump leakage,2 cases of intra-abdominal infection,6 cases of intestinal obstruction,5 cases of pulmonary infection,2 cases of incision infection,2 cases of delayed gastric emptying,3 cases of pulmonary infection combined with atelectasis,2 cases of anastomotic leakage combined with intra-abdominal infection,and 1 case of pulmonary infection and intra-abdominal infection combined with intestinal obstruction.Pulmonary infection,intestinal obstruction,and anastomotic leakage were the main postoperative complications of DG.The surgical approach was an independent risk factor for postoperative complications(P<0.05),and there was no statistically significant difference in the grade of postoperative complications of patients with different surgical methods(P>0.05).Conclusions Pulmonary infection,intestinal obstruction,abdominal infect

关 键 词：胃肿瘤 手术后并发症 危险因素 远端胃大部切除术 Clavien-Dindo 

分 类 号：R735.2[医药卫生—肿瘤]