进展期胃癌行腹腔镜与开腹根治术围手术期并发症对照研究

Perioperative complication incidence between laparoscopic and open radical resection for advanced gastric cancer: A case control study

目的探讨进展期胃癌腹腔镜与开腹根治手术围手术期并发症发生率的差异及影响术后并发症的相关因素。方法对2010年1月至2011年12月在福建医科大学附属协和医院胃外科施行胃癌根治术病人,采用逐一配对法进行配对,最终纳入腹腔镜手术组148例,开腹手术组148例。对比两组术中与术后1个月内并发症发生情况,并对全组术后并发症的相关因素进行多因素回归分析。结果腹腔镜组与开腹组术中并发症发生率分别为4.1%与4.7%,差异无统计学意义(P>0.05)。腹腔镜组和开腹组术后并发症发生率分别为10.8%和20.9%,二者差异具有统计学意义(P<0.05);其中,腹腔镜组和开腹组术后肠梗阻、肺部感染的发生率分别为1.4%和6.1%、3.4%和9.5%,差异均具有统计学意义(P<0.05);而术后其他并发症发生率比较差异均无统计学意义(P>0.05)。单因素分析显示,浸润深度、淋巴结转移、手术时间和是否腹腔镜手术与胃癌根治术后并发症发生密切相关(P<0.05)。多因素回归分析发现,是否腹腔镜手术和手术时间是影响胃癌根治术后并发症发生的独立危险因素(P<0.05)。结论进展期胃癌腹腔镜根治手术的术中并发症发生率与开腹手术差异无统计学意义,但术后并发症发生率低于开腹手术。是否腹腔镜手术和手术时间是影响进展期胃癌根治术后并发症发生的独立危险因素。

Objective To compare the surgical complication incidence between laparoscopy-assisted gastrectomy （LAG） and open gastrectomy （OG） for advanced gastric cancer （AGC） and the related risk factors of postoperative complications after radical gastrectomy. Methods A retrospective case-control study was performed comparing LAG and OG for AGC.A total of 148 patients with AGC underwent LAG between January 2010 and December 2011 in Affiliated Union Hospital of Fujian Medical University were enrolled and were compared with 148 AGC patients underwent OG during the same period. The perioperative complication morbidity and mortality were compared between the two groups. The risk factors determined postoperative complications were investigated by univariate and multivariate analysis. Results The intraoperative complication incidence was 4.1% in LAG group and 4.7% in OG group（P 〉 0.05）. The postoperative complication incidence was 10.8% in LAG group and 20.9% in OG group（P 〈 0.05 ）, among which the complication incidence of postoperative intestinal obstruction was 1.4% and 6.1% in LAG group and in OG group （P 〈 0.05）,and the complication incidence of postoperative pulmonary infection was 3.4% and 9.5% in LAG group and in OG group （P〈0.05）.There was no significant difference between the two groups in other postoperative complication incidence （P〉 0.05）. According to univariate analysis, depth of invasion, lymph node metastasis, operation time and laparoscopie surgery were related to postoperative complications （P〈0.05）. Muhivariate logistic regression analysis showed that whether laparoscopic surgery and operation time were independent risk factors for postoperative complications （P 〈 0.05）. Conclusion There is no difference in intraoperative complication incidence between LAG and OG groups. But the postoperative complication incidence is significantly lower in LAG group than that in OG group.Whether laparoscopic surgery is an independent risk factor for postoperative complications in advanced gastric cancer.