胃癌根治术联合D2淋巴结清扫术患者术后吻合口瘘的相关因素分析

Analysis in related factors of postoperative anastomotic fistula in patients with gastrectomy and D2 lymph node dissection

目的探讨胃癌根治术联合D2淋巴结清扫术患者术后吻合口瘘的相关因素。方法选取行胃癌根治术联合D2淋巴结清扫术的患者300例,其中未发生术后吻合口瘘的290例患者设为观察组,发生的10例设为对照组。比较2组患者一般临床资料、实验室指标(血红蛋白、白蛋白水平、血肌酐、血尿酸、PT-4NR)及手术时间、术中出血量、联合脏器切除、全胃或远端胃切除、术后腹腔感染。结果观察组年龄显著低于对照组(P<0.01),观察组合并糖尿病患者比例显著低于对照组(P<0.01)。观察组白蛋白水平显著高于对照组(P<0.01)。观察组的手术出血量显著少于对照组(P<0.01),术后腹腔感染比例、联合脏器切除比例显著低于对照组(P<0.01)。结论胃癌根治术联合D2淋巴结清扫术患者术后吻合口瘘的发生与患者的白蛋白水平、手术出血量、术后腹腔感染及联合脏器切除等密切相关。

Objective To explore the related factors of postoperative anastomotic fistula in patients with gastrectomy and D2 lymph node dissection. Methods A total of 300 patients treated by gastrectomy combined with D2 lymph node dissection were selected,and 290 cases without postoperative anastomotic fistula were designed as observation group,the rest 10 cases with postoperative anastomotic fistula were designed as control group. General materials,laboratory indexes（ hemoglobin,albumin,creatinine,uric acid,PT-4NR） and operation time,blood loss,combined organ resection,total gastrectomy or distal stomach resection and postoperative abdominal infection were compared between two groups. Results Age of patients in the observation group was lower than that in the control group（ P 0. 01）,and ratio of patients with diabetes in the observation group was significantly lower than that in the control group（ P 0. 01）. Albumin level in the observation group was significantly higher than that in the control group（ P 0. 01）. Surgical bleeding in the observation group was significantly lower than that in the control group（ P 0. 01）,and proportion of infections and ratio of patients with organ resection in the observation group were significantly less and lower than those in the control group（ P 0. 01）. Conclusion Surgical blood loss,postoperative abdominal infection and combined organ resection are closely correlated with postoperative anastomotic fistula of patients treated with gastrectomy and D2 lymph node dissection.