胃癌切除术后死亡危险因素的Logistic回归分析

Risk Factors Related with Mortality Following Gastrectomy for Gastric Cancer by Logistic Regressive Analysis

目的探讨导致胃癌切除术后死亡的危险因素。方法对2001年6月～2007年6月青岛大学医学院附属医院与东营市人民医院2165例胃癌切除术后的临床资料进行回顾性分析,并采用Logistic回归分析研究导致胃癌切除术后死亡的危险因素。结果胃癌切除术后1个月内的并发症发生率为25.1%,病死率为1.1%;单因素Logistic回归分析结果显示,87个因素中有15个因素与胃癌切除术后死亡有关,依次为年龄、营养不良、慢性阻塞性肺疾病、糖尿病、心脏病、肝硬化、前白蛋白水平、凝血酶原时间、肿瘤分期(Ⅳ期)、肿瘤直径、肿瘤侵及周围脏器情况、胃切除方式、医师手术例数、术中失血量及手术时间;多因素Logistic回归分析显示,有7个独立危险因素与胃癌术后死亡的发生有关,包括心脏病、医师手术例数、肿瘤侵及周围脏器、慢性阻塞性肺疾病、年龄、术中失血量和前白蛋白水平。结论确定胃癌切除术后死亡危险因素,进行必要术前干预,对降低胃癌切除术后并发症和病死率至关重要。

Objective To investigate the main risk factors related with mortality following gastrectomy for gastric cancer patients.Methods 2165 gastric cancer patients underwent gastrectomy in Dongying People＇s Hospital and Affiliated Hospital of Medical College of Qingdao University were analyzed retrospectively between June 2001 and June 2007,and Logistic regression analysis was used to investigate the risk factors for postoperative mortality.Results The complication rate and postoperative mortality rate were 25.1% and 1.1% respectively one month after resection of gastric cancer.The univariate Logistic regression analysis showed that of 87 factors,there were 15 factors related to mortality after resection of gastric cancer,in regards to age,malnutrition,chronic obstructive pulmonary disease,diabetes,heart disease,liver cirrhosis,pre-albumin levels,prothrombin time,tumor stage（Ⅳ period）,tumor size,tumor invasion and the circumstances surrounding organs,stomach resection methods,surgical number,intraoperative blood loss and operation time respectively,while the multivariate Logistic analysis showed that heart diseases,surgeon＇s operative volume,invation to the adjacent organ,chronic obstructive pulmonary disease,age,blood loss and level of prealbumin were 7 independent risk factors correlated to mortality.Conclusion Identifying risk factors for mortality after resection of gastric cancer and necessary preoperative intervention are essential to reduce postoperative complications and mortality of gastric cancer.