腹腔镜恶性胃肠道肿瘤术后并发症发生的风险因素分析:一项前瞻性队列研究  

Risk factors associated with postoperative complications in patients with malignan gastrointestinal tumors undergoing laparoscopic surgery:a prospective cohort study

作　　者：周静[1] 刘霄 陈雪粉 ZHOU Jing;LIU Xiao;CHEN Xuefen(Department of General Surgery,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,P.R.China)

机构地区：[1]解放军总医院第一医学中心普通外科医学部,北京100853

出　　处：《中国普外基础与临床杂志》2024年第6期712-717,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的分析并识别接受腹腔镜手术的恶性胃肠道肿瘤患者术后并发症发生的风险因素。方法前瞻性选取2023年1月至2023年10月期间解放军总医院第一医学中心普通外科收治行腹腔镜恶性胃肠道肿瘤手术的500例患者作为研究对象,观察术后并发症(Clavien-DindoⅡ级及以上)发生情况,然后将500例患者分为有并发症组和无并发症组。对2组患者间术前身体基本状况以及与手术相关的手术时间和出血量进行对比分析,然后根据分析结果并结合临床经验,选择合适的变量纳入多因素二元logistic回归模型进行分析,以确定恶性胃肠道肿瘤患者术后并发症发生的风险因素。结果500例患者中453例患者术后未发生并发症(无并发症组),有47例患者术后出现了并发症(并发症组),发生率为9.4%。单因素分析结果显示:并发症组与无并发症组患者在性别、腹围、术前低白蛋白血症、饮酒史、蛋白质饮食习惯、原发疾病、手术时间及术中出血量方面的差异有统计学意义(P<0.05),而2组患者在年龄、体质量指数、术前握力值、6 m步行试验时间、术前贫血、高血压、糖尿病、心脑血管疾病、吸烟史、文化程度、运动习惯及术前NRS 2002营养评分方面的差异均无统计学意义(P>0.05)。多因素二元logistic回归分析结果显示:性别、日常蛋白质饮食及运动频率、手术时间>200 min及术中出血量>150 mL可作为恶性胃肠肿瘤患者术后并发症发生的独立预测因素(P<0.05)。结论对于日常蛋白进食少、缺乏锻炼、手术时间长且术中出血多的女性恶性胃肠肿瘤患者,应做好围手术期管理,警惕术后并发症的发生。Objective To conduct an analysis and identify potential risk factors associated with postoperative complications in patients diagnosed with malignant gastrointestinal tumors who underwent laparoscopic surgery.Methods From January 2023 to October 2023,500 patients with malignant gastrointestinal tumors who underwent laparoscopic surgery at the Department of General Surgery,the First Medical Center of PLA General Hospital were prospectively selected as the research objects.The incidence of postoperative complications(Clavien-Dindo grade Il and higher)was observed,and then 500 patients were divided into a complication group and a non-complication group.The preoperative physical conditions,operative time and bleeding volume related to the operation were compared and analyzed between the two groups.According to the analysis results and clinical experience,appropriate variables were selected to be included in the multivariate binary logistic regression model for analysis,in order to determine the risk factors for postoperative complications in patients with malignant gastrointestinal tumors.Results Of the 500 patients,453 had no postoperative complications(non-complication group),and 47 had postoperative complications(complication group),with an incidence of 9.4%.Univariate analysis showed that there were significant differences between the complication group and the non-complications group in gender,abdominal girth,preoperative hypoalbuminemia,drinking history,protein diet habits,primary diseases,operative time and intraoperative blood loss(P<0.05),while there were no significant differences between the two groups in age,body mass index,preoperative grip strength,6 m walking test time,preoperative anemia,hypertension,diabetes,cardiovascular and cerebrovascular diseases,smoking history,education level,exercise habits and preoperative NRS 2002 nutritional score(P>0.05).Multivariate binary logistic regression analysis showed that gender,daily protein diet and exercise frequency,operation time>200 min and intraoperative b

关 键 词：腹腔镜 恶性胃肠道肿瘤 并发症 风险因素 

分 类 号：R735[医药卫生—肿瘤]