胃癌远端胃术后残胃胃瘫影响因素Logistic回归分析

Factors for Gastroparesis after Distal Subtotal Gastrectomy:Binary Logistic Regression Analysis

目的探讨胃癌远端胃术后残胃胃瘫发生的影响因素。方法回顾性分析胃癌行远端胃大部分切除(D2+)手术患者618例的临床资料。以手术后是否发生胃瘫为因变量,进行χ2检验单因素分析,多因素非条件Logistic逐步回归分析。结果术后发生胃瘫43例。单因素分析显示,在16个因素中与女性、糖尿病史、围手术期高血糖、术前营养状况不良、焦虑、术后第2天低蛋白血症、术中保留迷走神经干及术中置营养管鼻饲流质有关,多因素分析显示与女性、围手术期高血糖、焦虑、术后第2天低蛋白血症、术中置空肠营养进流质、术中保留迷走神经干有关。结论女性、围手术期高血糖、焦虑、术后第2天低蛋白血症为术后胃瘫的危险因素;而术中置营养管鼻饲流质、术中保留迷走神经为术后胃瘫的保护性因素。

Objective To explore the risk and protective factors for postsurgical gastroparesis syndrome （PGS） following distal subtotal gastrectomy. Methods Binary logistic regression was employed to analyze the clinical data of 618 patients who underwent distal subtotal gastrectomy （D^2＋） within the period of January 1998 to January 2009. Results Forty-three patients suffered PGS after distal subtotal gastrectomy. Chi-Square test showed that 8 of the 16 factors were related to PGS following distal subtotal gastrectomy, including female gender, diabetes history, preoperative and postoperative high blood glucose level, preoperative malnutrition, preoperative and postoperative anxiety, postoperative hypoproteinemia, the placement of nutrition tube in jejunum during the treatment, and the protection of vagus nerve during the operation; binary logistic regression analysis found that 6 factors were related to PGS, including female gender, preoperative and postoperative high blood glucose level, preoperative and postoperative anxiety, postoperative hypoproteinemia, the placement of nutrition tube in jejunum during the surgery, and the protection of vagus nerve in the operation. Conclusion The risk factors for postsurgical gastroparesis syndrome following distal subtotal gastrectomy are female gender, preoperative and postoperative high blood glucose level, preoperative and postoperative anxiety, and postoperative hypoproteinemia; the protective factors are the placement of nutrition tube in jejunum during the treatment, and the protection of vagus nerve in the course of operation.