合并肝硬化门脉高压症胃癌患者手术后并发症的危险因素分析

Risk factor analysis of postoperative complications in gastric carcinoma patients complicated with liver cirrhosis

目的：分析胃癌合并肝硬化患者术后并发症的危险因素。方法回顾性分析解放军南京第八一医院普通外科2000年1月至2013年12月间41例合并肝硬化胃癌手术患者的临床资料，采用Logistic回归模型分析术后并发症的危险因素。结果全组无手术死亡病例，术后27例（65．9％）患者出现并发症，按发病频数依次为腹水（15例）、肺部感染（8例）、出血（5例）、切口感染（4例）、术后肝肾功能障碍（4例）、胃排空延迟（3例）、膈下感染（2例）和胰瘘（1例）。多因素回归分析显示，肝功能Child分级（OR＝27．96，95％ CI：1．16～672．23）、血清白蛋白（OR＝17．98，95％ CI：1．28～253．36）和术中出血量（OR＝10．60，95％ CI：1．21～92．82）是术后并发症的独立危险因素。结论对于合并肝硬化的胃癌患者，应积极进行围手术期处置，调整术前Child分级，并于术中遵循损伤控制原则，减少出血量，从而有效减少术后并发症的发生。

Objective To analyze the risk factors of postoperative complications in gastric carcinoma patients complicated with liver cirrhosis. Methods A retrospective research of 41 gastric cancer patients with liver cirrhosis who underwent surgical therapy was performed. The multivariate Logistic regression analysis was carried out to determine risk factors of postoperative complications. Results There were no postoperative death in this cohort. Twenty-seven （65.9%） patients developed postoperative complications. As determined by the Logistic regression analysis , Child-Pugh score （OR=27.96, 95% CI：1.16-672.23）, albumin level （OR=17.98, 95% CI：1.28-253.36） and intraoperative blood loss （OR=10.60, 95%CI：1.21-92.82） were independent risk factors of postoperative complications. Conclusion As for gastric cancer patients with liver cirrhosis, positive perioperative management, adjustment of Child-Pugh classifications score, following damage control principle during operation and reducing the intraoperative bleeding may decrease the morbidity of postoperative complications.