胃癌术后十二指肠残端瘘的危险因素分析

Post-gastrectomy duodenal stump fistula in gastric cancer patients

目的探讨胃癌术后并发十二指肠残端瘘的主要危险因素。方法2008年9月至2014年10月问在皖南医学院附属弋矶山医院行胃癌根治术420例患者中21例并发十二指肠残端瘘，对可能导致胃癌术后并发十二指肠残端瘘的非手术因素和手术因素进行单因素及多因素Logistic回归分析。结果单因素分析发现，本组胃癌患者术前并存糖尿病和肝硬化、术前血清白蛋白水平、术前血红蛋白水平、消化道重建方式、十二指肠残端是否包埋均与术后并发十二指肠残端瘘有关（均P〈0．05）。多因素Logistic回归分析发现，胃癌患者术前并存肝硬化（OR为5．369，P=0．016）、术前血红蛋白水平（OR为5．66，P=0．011）和消化道重建方法（OR为3．82，P=0．015）是术后并发十二指肠残端瘘的独立危险因素。结论胃癌患者术前并存肝硬化、术前血红蛋白水平和消化道重建方式是术后并发十二指肠残端瘘的主要危险因素。

Objective To investigate the main risk factors for duodenal stump fistula after radical gastrectomy. Methods The data from 420 gastric cancer patients undergoing Billroth type ]I or Roux-en-Y digestive tract reconstruction after gastrectomy in the affiliated Yijishan Hospital of Wannan Medical College between September 2008 and October 2014 were analyzed retrospectively. Firstly, single factor analysis was used in non-operative and operative variables. Then, multivariate Logistic regression analysis was performed in the selected variables. Results 6 variables, including diabetes, hepatoeirrhosis, serum level of albumin, serum level of hemoglobin, mode of digestive tract reconstruction, embedding of the duodenal stump were found to be most strongly associated with the occurrence of duodenal stump fistula （P 〈0. 05）. By Logistic regression analysis, it was revealed that hepatocirrhosis （OR 5. 369, P=0. 016）, serum level of hemoglobin （OR 5. 66 ,P = 0.011 ）, digestive tract reconstruction （OR 3.82 ,P = 0. 015 ） were 3 independent risk factors correlated to duodenal stump fistula. Conclusions Hepatocirrhosis, serum level of hemoglobin and the mode of digestive tract reconstruction are major risk factors correlated to duodenal stump fistula in patient undergoing radical gastrectomy for gastric carcinoma.