胃癌腹膜种植患者手术并发症的危险因素分析及护理体会

Relative risks factors and nursing management of postoperative complication after palliative surgery in gastric cancer patients with peritoneal dissemination

目的探讨胃癌腹膜种植患者姑息手术术后并发症的危险因素和相应的护理措施。方法回顾性分析2000年1月至2014年4月在本中心诊治的464例胃癌腹膜种植患者的临床资料,分析其术后并发症的危险因素和临床护理相应措施。结果 5.82%(27/464)的胃癌腹膜转移患者姑息性手术后出现相关并发症,包括:肠梗阻4例(0.86%)、腹腔感染7例(1.51%)、吻合口瘘3例(0.65%)、消化道出血2例(0.43%)、吻合口狭窄2例(0.43%)、急性胰腺炎2例(0.43%)、胃瘫1例(0.22%)、肺部感染4例(0.86%)、急性肾衰竭1例(0.22%)、脑血管意外1例(0.22%)。姑息性胃切除是影响患者术后并发症发生的危险因素(P=0.017)。结论姑息性胃切除术是胃癌腹膜种植患者术后并发症发生的影响因素,加强临床护理可以早期发现并处理术后并发症。

Objective To explore the associated risks factors of postoperative complication after palliative surgery in gastric cancer patients with peritoneal dissemination and summarize the nursing management. Methods The clinical data of 464 gastric cancer patients with peritoneal dissemination were analyzed retrospectively. The risk factors determined postoperative complications were investigated by univariate analysis. Results 5.82% （27/464） patients with peritoneal metastases of gastric cancer hadcomplications after palliative surgery, including four cases of intestinal obstruction （0.86%）, seven cases of abdominal infection （1.51%）, three cases of anastomotic fistula（0.65%）, two cases of gastrointestinal bleeding （0.43%）, two cases of anastomotic stenosis （0.43%）, two cases of acute pancreatitis （0.43%）, one cases of gastroparesis（0.22%）, four cases of pulmonary infection （0.86%）, one cases with acute renal failure （0.22%）, one cases of cerebral vascular accident （0.22%）. Palliative gastrectomy was a risk factor for postoperative complications （ P =0.017）. Conclusions Palliative gastrectomy is a risk factor for patients with peritoneal metastases of gastric cancer. To strengthen the clinical nursing can be early detection and treatment of postoperative complications.