一项基于全国多中心前瞻性登记队列研究(PACAGE)的中国胃癌和结直肠癌患者术后并发症现状分析  

Incidence of postoperative complications in Chinese patients with gastric or colorectal cancer based on a national,multicenter,prospective,cohort study

作　　者：张书勤 吴舟桥[2] 霍博文 徐惠宁 赵康[3] 靖昌庆 刘凤林 余江[6] 李正荣[7] 张健 臧潞[9] 蒿汉坤[10] 郑朝辉[11] 李勇[12] 樊林 黄华[5] 梁品[14] 吴斌[15] 朱甲明 牛兆建[17] 朱玲华 宋武[19] 尤俊 燕速[3] 李子禹[2] Zhang Shuqin;Wu Zhouqiao;Huo Bowen;Xu Huining;Zhao Kang;Jing Changqing;Liu Fenglin;Yu Jiang;Li Zhengrong;Zhang Jian;Zang Lu;Hao Hankun;Zheng Chaohui;Li Yong;Fan Lin;Huang Hua;Liang Pin;Wu Bin;Zhu Jiaming;Niu Zhaojian;Zhu Linghua;Song Wu;You Jun;Yan Su;Li Ziyu(Department of Public Health,Qinghai University School of Medicine,Xining 810001,China;Gastrointestinal Cancer Center,Beijing Cancer Hospital,Beijing 100142,China;Department of Gastrointestinal(Oncology)Surgery,Affiliated Hospital of Qinghai University,Xining 810001,China;Department of Gastrointestinal Surgery,Shandong Provincial Hospital,Jinan 250021,China;Department of Gastric Surgery,Cancer Hospital,Fudan University,Shanghai 200025,China;Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Zhejiang University,Hangzhou 310003,China;Department of Gastrointestinal Surgery,Ruijin Hospital,Shanghai Jiao Tong University,Shanghai 200025,China;Department of Gastrointestinal Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Gastroenterology,Union Hospital of Fujian Medical University,Fuzhou 350001,China;Department of Gastrointestinal Surgery,Guangdong Provincial People's Hospital,Guangzhou 510080,China;Department of General Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Gastrointestinal Surgery,the First Hospital of Dalian Medical University,Dalian 116011,China;Department of Basic Surgery,Union Hospital of Peking Union Medical College,Beijing 100032,China;Department of Gastrointestinal Oncology,the First Affiliated Hospital of China Medical University,Shenyang 110002,China;Department of Gastrointestinal Surgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Gastrointestinal Surgery,Run Run Shaw Hospital,Zhejiang University,Hangzh

机构地区：[1]青海大学医学部公共卫生系青海大学附属医院,西宁810001 [2]北京大学肿瘤医院胃肠肿瘤中心,北京100142 [3]青海大学附属医院胃肠肿瘤外科,西宁810001 [4]山东第一医科大学附属省立医院胃肠外科,济南250021 [5]复旦大学附属肿瘤医院胃外科,上海200025 [6]南方医科大学附属南方医院普通外科,广州510515 [7]南昌大学附属第一医院胃肠外科,南昌330006 [8]浙江大学附属第一医院胃肠外科,杭州310003 [9]上海交通大学医学院附属瑞金医院胃肠外科,上海200025 [10]复旦大学附属华山医院胃肠外科,上海200040 [11]福建医科大学附属协和医院胃外科,福州350001 [12]广东省人民医院胃肠外科,广州510080 [13]西安交通大学附属第一医院普通外科,西安710061 [14]大连医科大学附属第一医院胃肠外科,大连116011 [15]中国协和医科大学附属协和医院基本外科,北京100032 [16]中国医科大学第一附属医院胃肠肿瘤外科,沈阳110002 [17]青岛大学附属医院胃肠外科,青岛266000 [18]浙江大学附属邵逸夫医院胃肠外科,杭州310009 [19]中山大学第一附属医院胃肠外科,广州510062 [20]厦门大学第一附属医院胃肠肿瘤外科,厦门361003 [21]徐州医科大学附属宿迁医院感染管理科

出　　处：《中华胃肠外科杂志》2024年第3期247-260,共14页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金重点项目联合基金(U20A20371);北京大学临床医学+X青年项目(PKU2022LCXQ038);海淀培育(HP2023-19-503001)。

摘　　要：目的探讨我国胃癌和结直肠癌患者术后并发症的发生率,并评估其危险因素。方法本研究采用全国多中心前瞻性数据登记队列研究方法,数据来自中国胃肠肿瘤外科联盟发起的胃肠外科手术后腹部并发症现状研究数据库(PACAGE)。PACAGE数据库自2018年12月至2020年12月期间,前瞻性收集了20家医学中心胃癌和结直肠癌患者一般人口统计学数据、围手术期治疗及术后并发症相关数据,根据是否发生术后并发症进行分组,参照胃肠肿瘤外科术后并发症相关专家共识和Clavien-Dindo分级标准,对并发症进行分类及分级。通过绘制热图,将不同分级的术后并发症发生率可视化;采用多因素非条件logistic回归模型,分析发生术后并发症的独立危险因素。结果共纳入3926例胃癌和结直肠癌患者,657例患者共发生876例次术后并发症,总体并发症发生率16.7%(657/3926),Ⅲ级及以上严重并发症发生率4.0%(156/3926),Ⅴ级并发症发生率0.2%(7/3926)。胃癌患者2271例,术后并发症发生率18.1%(412/2271),严重并发症发生率4.7%(106/2271);结直肠癌患者1655例,术后并发症发生率14.8%(245/1655),严重并发症发生率3.0%(50/1655)。胃癌和结直肠癌患者吻合口漏的发生率分别是3.3%(74/2271)和3.4%(56/1655)。腹腔感染在各类并发症中占比最高,在胃癌和结直肠癌患者中分别为28.7%(164/572)和39.5%(120/304)。在所有术后并发症严重程度分级中,Ⅱ级并发症占比最高,胃癌和结直肠癌分别占65.4%(374/572)和56.6%(172/304)。多因素分析显示:(1)胃癌组患者发生术后并发症的独立影响因素包括:有术前合并症(OR=2.54,95%CI:1.51~4.28,P<0.001)、接受新辅助治疗(OR=1.42,95%CI:1.06~1.89,P=0.020)、美国麻醉医师协会评分较高(ASA,2分:OR=1.60,95%CI:1.23~2.07,P<0.001;≥3分:OR=0.43,95%CI:0.25~0.73,P=0.002)、手术时间>180 min(OR=1.81,95%CI:1.42~2.31,P<0.001)、术中出血量>50 ml(OR=1.29,95%CI:1.01~1.63,P=0.038)和相�Objective To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer,and to evaluate the risk factors for postoperative complications.Methods This was a national,multicenter,prospective,registry-based,cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastroenterological Surgery(PACAGE)study sponsored by the China Gastrointestinal Cancer Surgical Union.The PACAGE database prospectively collected general demographic characteristics,protocols for perioperative treatment,and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020.The patients were grouped according to the presence or absence of postoperative complications.Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria.The incidence of postoperative complications of different grades are presented as bar charts.Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression.Results The study cohort comprised 3926 patients with gastric or colorectal cancer,657(16.7%)of whom had a total of 876 postoperative complications.Serious complications(Grade Ⅲ and above)occurred in 4.0% of patients(156/3926).The rate of Grade V complications was 0.2%(7/3926).The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1%(412/2271)and serious complication rate of 4.7%(106/2271);and 1655 with colorectal cancer,with a postoperative complication rate of 14.8%(245/1655)and serious complication rate of 3.0%(50/1655).The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3%(74/2271)and 3.4%(56/1655),respectively.Abdominal infection was the most frequently occurring complication,ac

关 键 词：胃肿瘤 结直肠肿瘤 术后并发症 风险因素 

分 类 号：R735.2[医药卫生—肿瘤] R735.34[医药卫生—临床医学]