腹腔镜远端胃癌根治术后并发症及预后危险因素分析

Analysis of risk factor for postoperative complications and prognostic factor following laparoscopic assisted distal gastrectomy for gastric cancer

目的 ：探讨腹腔镜辅助远端胃癌根治（LADG）术后并发症发生及远期预后的影响因素。方法 ：收集2004年1月至2011年12月228例我科行LADG病人的临床病理资料,分析腹腔镜胃癌根治术后并发症发生及远期预后的影响因素。病人随访至2013年12月。结果：本研究33例发生术后并发症,发生率14.5%,主要为吻合口漏和狭窄、腹腔出血等。单因素分析表明：高龄（〉70岁）、吻合方式和淋巴结转移为影响术后并发症发生的危险因素（P〈0.05）。多因素分析表明：高龄以及毕Ⅱ式和Roux-en-Y吻合为影响术后并发症发生的独立因素（P〈0.05）。本研究随访中位时间43（2~117）个月,死亡33例,5年生存率82.9%。单因素分析表明：肿瘤分期、浸润程度、淋巴结转移、p TNM分期、肿瘤直径、吻合方式、术中出血量、手术时间、淋巴结清扫方式以及病理类型为影响LADG术后病人预后的危险因素（P〈0.05）。多因素分析表明：淋巴结转移以及病理类型为影响LADG术后病人预后的独立危险因素（P〈0.05）。结论 ：高龄以及吻合方式是LADG术后并发症发生的独立危险因素。此外,淋巴结转移以及病理类型是术后远期预后的独立危险因素,可为临床判断胃癌预后提供依据。

Objective To identify risk factors for postoperative complications and prognostic factor for long-term survival following laparoscopie assisted distal gastrectomy （LADG） for gastric cancer. Methods The clinicopathologic data were collected with 228 patients during LADG with lymph node dissection for gastric cancer between Ja-nuary 2004 and December 2011 in our department. Patients were followed until December 2013. The risk factors for both postoperative complications and prognosis of long-term survival of LADG were evaluated and analyzed. Results Thirty-three cases （14.5%） had postoperative complications most of which were leak or stricture of anastmosis, peritoneal bleeding. Univariate analysis showed that the factors which influenced the postoperative complications significantly were old age （〉70 years）, lymphnode metastasis and anastomosis type （P〈0.05）. Multivariate analysis of these risk factors showed that old age, and anastomotic procedure （Billroth Ⅱ and Roux-en-Y） were independent risk factors for postoperative complications （P〈0.05）. The median duration of postoperative follow-up was 43 （2-117） month. The 5 year survival was 82.9% with 33 cases died of gastric cancer. The risk factors associated with prognosis of long-term survival after LADG were gotten from univariate analysis as follow： cancer stage, depth of invasion, lymphnode metastasis, pTNM stage, diameter of tumor, type of anasto- mosis, intraoperative bleeding, operation time, extent of lymph node dissection and pathological type （differentia-ted or undifferentiated） （P〈0.05）. However, lymphnode metastasis and pathological type were found to be the only independent factors in multivariate analysis （P〈0.05）. Conclusions Old age and type of anastomotie procedure were gotten as independent risk factors for postoperative complications. Lympbnode metastasis and pathological type were found to be independent risk factors for overall survival after LADG which would be the clue for further study on prognosis of gastric cancer.