腹腔镜胃癌根治术对伴发慢性阻塞性肺病患者的影响

Feasibility of radical laparoscopy-assisted gastrectomy for patients with chronic obstructive pulmonary disease

目的探讨腹腔镜胃癌根治术治疗伴发慢性阻塞性肺病（COPD）胃癌患者的可行性。方法回顾性分析第三军医大学西南医院2010年1月至2013年10月实施胃癌根治术的340例伴发COPD胃癌患者的临床资料，其中78例行开腹手术（开腹组），262例行腹腔镜手术（腹腔镜组．腹内压维持在8～10mmHg），比较两组术后肺部并发症的发生情况以及与术后肺部并发症发生的相关因素。结果腹腔镜组的手术时间[（220．4±19．1）rain]明显长于开腹组[（194．2±31．5）min，P=0．000]，而术中失血量[（131．2±14．7）m1]明显小于开腹组[（246．7±49．0）ml，P=0．000]。腹腔镜组和开腹组患者术后肺部并发症发生率分别为5，3％（14／262）和15．4％（12／78），差异有统计学意义（P=0．003）。多因素分析结果显示，COPD严重程度是术后出现肺部并发症的独立影响因素（P=0．031，HR=2．456，95％CI：1．306～1．789），而采用腹腔镜手术还是开腹手术不是其独立影响因素（P=0．126）。结论应用较低腹内压的腹腔镜胃癌根治术治疗伴发轻、中度COPD的胃癌患者是安全可行的。

Objective To assess the effect of radical laparoscopy-assisted gastrectomy （LG）for patients with chronic obstructive pulmonary disease （COPD）. Methods Clinical data of 340 gastric cancer patients with COPD undergoing radical gastrectomy with lymphadenectomy at Southwest Hospital, Third Military Medical University between January 2010 and October 2013 were analyzed retrospectively. The clinical outcomes for the 262 patients with COPD who underwent LG （LG group） were compared with those of 78 patients with COPD who underwent open gastreetomy （OG group）. During LG, pneumoperitoneum was maintained at an insuffiation pressure of 8 mmHg to 10 mmHg. The primary endpoint was postoperative pulmonary complication （PPC）. To predict factors related to PPC, univariate and multivariate logistic analyses were carried out. Results Intraoperative blood loss was significantly less in the LG group E （131.2±14.7） roll than in the OG group E （246.7±49.0） ml; t=-13.445, P=0.000 ], but operation time was significantly longer E （220.4± 19.1 ） rain vs. （194.2±31.5） rain ; t=6.877, P=0.000 ]. The findings showed PPC to be significantly less frequent in the LG group （5.3%, 14/262 ） than in the OG group （15.4%, 12/78）（ X2=8.581, P=0.003）. The severity of COPD was independent risk factor for PPC（P=0.031, HR=1.456, 95%C1： 1.306-1.789）. No independent predictor of PPCs was found in type of operative approach （open vs laparoscopic; P=0.126）. Conclusion The LG procedure with insuffiation pressure of pneumoperitoneum is tolerated for gastric cancer patients with mild or moderate COPD.