老年患者腹腔镜胃癌根治术后发生并发症影响因素分析的多中心研究  

Analysis of influencing factors for postoperative complications in elderly patients receiving laparoscopic radical gastrectomy of gastric cancer:a multicenter study

作　　者：王晓娜 赵永捷[2] 张自立[3] 杨涛[4] 宋国栋[5] 于向阳 刘旭东 白建平 李昊天 张树朋[9] 梁寒 Wang Xiaona;Zhao Yongjie;Zhang Zili;Yang Tao;Song Guodong;Yu Xiangyang;Liu Xudong;Bai Jianping;Li Haotian;Zhang Shupeng;Liang Han(Department of Gastric Oncology,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy of Tianjin,Tianjin′s Clinical Research Center for Cancer,Tianjin 300060,China;Department of General Surgery,Tianjin People′s Hospital,Tianjin 300191,China;Department of Gastrointestinal Surgery,Tianjin Third Central Hospital,Tianjin 300170,China;Department of Gastrointestinal Surgery,Tianjin First Central Hospital,Tianjin 300192,China;Department of Gastrointestinal Surgery,the Second Hospital of Tianjin Medical University,Tianjin 300211,China;The First Department of Gastrointestinal Surgery,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine,Nankai Hospital,Tianjin 300100,China;Department of General Surgery,the People′s Hospital of Jizhou District,Tianjin 301900,China;Department of General Surgery,the 983th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army,Tianjin 300142,China;Department of General Surgery,Tianjin Fifth Central Hospital,Tianjin 300450,China)

机构地区：[1]天津医科大学肿瘤医院胃部肿瘤科,国家恶性肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市恶性肿瘤临床医学研究中心,天津300060 [2]天津市人民医院基本外科,天津300191 [3]天津市第三中心医院胃肠外科,天津300170 [4]天津市第一中心医院胃肠外科,天津300192 [5]天津医科大学第二医院胃肠外科,天津300211 [6]天津市中西医结合医院,南开医院胃肠外一科,天津300100 [7]天津市蓟州区人民医院普通外科,天津301900 [8]中国人民解放军联勤保障部队第983医院普通外科,天津300142 [9]天津市第五中心医院普通外科,天津300450

出　　处：《中华消化外科杂志》2024年第3期386-391,共6页Chinese Journal of Digestive Surgery

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK‑009A)。

摘　　要：目的探讨≥70岁患者腹腔镜胃癌根治术(LG)后发生并发症的影响因素。方法采用回顾性病例对照研究方法。回顾性分析2020年1月至2022年12月天津医科大学肿瘤医院等天津市10家医学中心收治的370例≥70岁胃癌患者的临床病理资料;男281例,女89例;年龄为(74±4)岁。根据患者术后并发症发生情况分为术后发生并发症和术后未发生并发症。观察指标:(1)≥70岁胃癌患者LG开展情况。(2)≥70岁胃癌患者LG手术情况。(3)≥70岁胃癌患者LG后发生并发症的影响因素分析。正态分布的计量资料以x±s表示。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示,组间比较采用χ2检验。等级资料比较采用非参数秩和检验。单因素分析根据资料类型选择对应的统计学方法。多因素分析采用Logistic回归模型。结果(1)≥70岁胃癌患者LG开展情况。2020―2022年,370例≥70岁胃癌患者中,212例行完全LG,158例行腹腔镜辅助胃癌根治术;2020年63例LG患者中,完全LG的比例为41.27%(26/63),2021年133例LG患者中,完全LG的比例为54.14%(72/133),2022年174例LG患者中,完全LG的比例为65.52%(114/174)。(2)≥70岁胃癌患者LG手术情况。370例≥70岁胃癌患者手术时间为(221±82)min,清扫淋巴结数目为30(5~85)枚,转移淋巴结数目为2(0~76)枚。370例患者中,D2淋巴结清扫326例,D1及D1+淋巴结清扫44例;R0切除360例,R1切除10例。99例患者术后发生并发症,其中≥3级并发症42例,因术后并发症行2次手术6例,围手术期死亡4例。370例患者术后病理学分期:Ⅰ期90例、Ⅱ期66例、Ⅲ期205、Ⅳ期9例。(3)≥70岁胃癌患者LG后发生并发症的影响因素分析。多因素分析结果显示:性别、美国麻醉医师协会(ASA)分级、淋巴结清扫范围、手术时间是≥70岁胃癌患者LG后发生并发症的独立影响因素(风险比=0.449,2.088,5.184,2.646,95%可信区间为0.234~0.859,1.059~4.119,1.522~17.Objective To investigate the factors influencing postoperative complications in patients over 70 years old who underwent laparoscopic radical gastrectomy of gastric cancer.Methods The retrospective case-control study was conducted.The clinicopathological data of 370 gastric cancer patients over 70 years old who were admitted to 10 medical centers,including Tianjin Medical University Cancer Institute&Hospital et al,from January 2020 to December 2022 were collected.There were 281 males and 89 females,aged(74±4)years.All patients were divided into the patients with postoperative complications and the patients without postoperative complications,respectively.Observation indicators:(1)implementation of laparoscopic radical gastrectomy in gastric cancer patients over 70 years old;(2)surgical conditions of gastric cancer patients over 70 years old who underwent laparoscopic radical gastrectomy;(3)analysis of factors influencing postoperative complications in gastric cancer patients over 70 years old who underwent laparoscopic radical gastrectomy.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test.Comparison of ordinal data was conducted using the non-parameter rank sum test.Univariate analysis was conducted using corresponding methods based on data types.Multivariate analysis was conducted using the Logistic regression model.Results(1)Implementation of laparoscopic radical gastrectomy in gastric cancer patients over 70 years old.Of the 370 gastric cancer patients over 70 years old who were admitted from 2020 to 2022,there were 212 cases undergoing total laparoscopic gastrectomy,and 158 cases undergoing laparoscopic assisted radical gastrectomy,respectively.In 2020,among 63 patients who underwent laparoscopic radical gastrectomy for gastric cancer,the proportion of totally laparoscopic radical gastr

关 键 词：胃肿瘤 老年 胃癌根治术 术后并发症 腹腔镜检查 

分 类 号：R735.2[医药卫生—肿瘤]