胃癌根治术后非计划再次手术的原因和危险因素分析

Risk factors of unplanned reoperation after radical gastric cancer surgery

目的通过对病例资料的回顾性研究分析胃癌根治术后非计划再次手术的原因和危险因素。方法回顾性分析2012年1月至2017年12月在南京大学医学院附属鼓楼医院行胃癌根治术(包括开腹和腹腔镜)的病人资料,纳入标准:(1)年龄18～80岁;(2)胃镜病理明确诊断胃癌;(3)接受D2胃癌根治术(包括开腹和腹腔镜手术)。排除标准:(1)胃癌术中行联合脏器切除术;(2)残胃癌行胃癌根治术。共统计胃癌手术病人3 213例,其中接受非计划再次手术病人37例。按照性别、年龄进行1∶2配对,以胃癌术后未接受再次手术的病人为对照组,开展回顾性配对研究,查找非计划再次手术的原因,同时分析导致发生非计划再次手术的危险因素。结果术后行非计划再次手术的中位时间为1d(0～9d),开腹术后31例,腹腔镜术后6例。手术原因包括:腹腔出血(23例,62.2%);吻合口出血(3例,8.1%);吻合口漏(3例,8.1%);切口裂开(2例);肠梗阻(2例);十二指肠残端漏(1例);急性胆囊炎(1例);脾梗死(1例);切口感染(1例)。单因素分析结果显示,非计划再次手术组与对照组的病人在术中出血量(P=0.014)、第一助手资格(P=0.042)方面差异有统计学意义,手术时间、主刀医生资格、手术开始时间、术中输血、手术方式、手术部位等方面差异无统计学意义。多因素Logistic回归分析显示:术中出血量≥200ml是非计划再次手术的独立危险因素(OR=1.827,95%CI:1.034,3.026,P=0.024)。结论腹腔出血是胃癌根治术后非计划再次手术的最常见原因,术中出血量≥200ml是非计划再次手术的独立危险因素。

Objective To explore the risk factors of unplanned reoperation after radical gastrectomy for gastric cancer patients.Methods We retrospectively analyzed the data of patients undergoing gastric cancer radical gastrectomy in Nanjing Drum Hospital from Jan.2012 to Dec.2017.The inclusion criteria included:(1)age 18-80 years;(2)gastric cancer confirmed endoscopic pathologically;(3)unplanned reoperation after radical gastrectomy.The exclusion criteria included:(1)combined multiple organ resection;(2) gastric stump cancer.We conducted a 1∶2 case-matched study according to age and gender.Reoperation group contained 37 cases of unplanned reoperation and control group had 74 cases who just accepted radical gastrectomy.Risk factors were examined by Logistic regression analysis.Results Total 37 cases accepted unplanned reoperations,including 31 cases after open surgery and 6 cases after laparoscopic surgery.The main cause of reoperation was abdominal bleeding(62.2%),and other causes included anastomotic bleeding(8.1%),anastomotic leakage(8.1%),incision dehiscence(5.4%),intestinal obstruction(5.4%),etc.Chi test showed there was significant difference in intraoperation bleeding≥200 ml(P=0.014)and title of first assistant(P=0.042)between two groups.Logistic analysis showed that intraoperation bleeding ≥200 ml was significant risk factor(OR=1.827,95%CI:1.034-3.126,P=0.024)for unplanned reoperation.Conclusions The main cause of unplanned reoperation is abdominal bleeding.Intraoperative bleeding ≥200 ml was a significant risk factor for unplanned reoperation.