既往腹部手术史对行腹腔镜辅助根治性全胃切除术患者的影响

Impact of previous abdominal operations on the outcome of laparoscopy-assisted radical total gastrectomy

目的探讨既往腹部手术史对行腹腔镜辅助根治性全胃切除术患者的影响。方法2008年1月至2010年12月间福建医科大学附属协和医院对328例胃癌患者施行腹腔镜辅助根治性全胃切除术，其中既往有腹部手术史者（PAS组）57例，无腹部手术史者（NPAS组）271例。比较两组患者术中及术后情况．并对影响术后并发症发生的危险因素进行单因素及多因素分析。结果PAS组和NPAS组平均淋巴结清扫数目分别为（30．2±10．5）和（31．1±9．4）枚／例，差异无统计学意义（P〉0．05）。与NPAS组相比，PAS组患者手术时间更长[（247．0±60．5）min比（214．7±57．0）min，P〈0．01]、术后并发症发生率更高[21．1％（12／57）比11．1％（30／271），P〈0．05]；但两组患者术中出血量、术中输血例数、中转开腹率、术后下床时间、术后排气时间、进食流质时间、胃管拔除时间和术后住院时间的差异均无统计学意义（P〉0．05）。多因素分析显示，既往腹部手术史并不是影响患者术后并发症发生的独立危险因素（P〉0．05）。结论既往有腹部手术史的胃癌患者行腹腔镜辅助根治洼全胃切除术是可行的。既往腹部手术史虽然会延长手术时间，但其并不是术后并发症的独立危险因素。

Objective To explore the impact of previous abdominal operations on the outcome of laparoscopy-assisted radical total gastrectomy （LATG）. Methods Clinical data of 328 patients with gastric cancer who underwent LATG from January 2008 to December 2010 were analyzed retrospectively. Among the patients, 57 cases had previous abdominal surgeries （PAS group） and 271 cases had no previous abdominal surgeries （NPAS group）. The intraoperative and postoperative parameters were compared, and risk factors associated with postoperative complications were analyzed using univariate and multivariate analysis. Results There was no significant difference between the two groups in the mean number of lymph nodes harvested （30.2± 10.5 vs. 31.1±9.4, P〉0.05）. The operative time [ （247.0± 60.5） min vs. （214.7±57.0） min, P〈0.01] and the postoperative complication rate[21.1%（12/57） vs. 11.1%（30/271 ）, P〈0.05 ] were significantly different between the two groups. However, there were no differences in intraoperative blood loss, transfused patients, conversion, postoperative ambulation time, postoperative flatus passage time, resumption of liquid diet, removal of gastric tube, and postoperative hospital stay （all P〉0.05）. Multivariate logistic regression analysis showed that previous abdominal surgeries was not an independent risk factor associated with postoperative complication morbidity （P〉 0.05）. Conclusions LATG is feasible for gastric cancer patients who has previous abdominal surgeries. Previous abdominal surgery may prolong operative time but is not an independent risk factor associated with postoperative complication.