腹腔镜辅助胃癌根治术并发症危险因素分析

Analysis of risk factors leading complications after laparoscopic-assisted radical gastrectomy

目的分析腹腔镜辅助胃癌根治术发生并发症的危险因素。方法回顾性分析上海交通大学医学院附属仁济医院胃肠外科2010年1月至2015年12月收治的245例行腹腔镜辅助胃癌根治术病人的临床资料,通过ROC曲线确定观察指标的临界值并分组,采用χ~2检验比较不同分组的并发症发生率,应用Logistic回归法进行多因素分析。结果 245例病人中33例(13.5%)术后出现并发症。在纳入分析的17个观察指标中,BMI≥25(χ~2=12.620,P<0.01)、伴发合并症>1种(χ~2=4.272,P=0.039)、血清白蛋白≤33 g/L(χ~2=6.805,P<0.01)、手术时间>230min(χ~2=7.976,P<0.01)、术中出血量>200 m L(χ~2=7.140,P<0.01)、围术期输血量>600 m L(χ~2=22.686,P<0.01)、肿瘤直径>2 cm(χ~2=9.812,P<0.01)、术者操作经验欠缺(χ~2=5.896,P=0.015)与腹腔镜辅助胃癌根治术并发症的发生率有关。多因素分析显示,血清白蛋白(≤33 g/L)、围手术期输血(>600 m L)和肿瘤直径(>2 cm)是术后并发症发生的独立影响因素。结论对于行腹腔镜辅助胃癌根治术病人,术前审慎评估全身情况、纠正低蛋白血症,术中操作精准以减少出血和输血,合理选择吻合方式,尽早度过学习曲线,可有效降低术后并发症的发生率。

Objective To explore the risk factors of the complications after laparoscopic-assisted radical gastrectomy. Methods The clinical data of 245 patients receiving laparoscopic-assisted radical gastrectomy in Department of GI Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine from January 2010 to December 2015 were analyzed retrospectively. The ROC curve was used to determine the critical value of the observed index, and the correlation between the factors and the incidence of complications was analyzed by X2 test. Logistic regression was used for multivariate analysis. Results Of the 245 patients undergoing laparoscopic-assisted radical gastrectomy, 33 patients （13.5%） had postoperative complications. Of the 17 indexes observed in the analysis, BMI≥25 （x^2=12.620, P〈0.01）, with more than 1 comorbidities （x^2=4.272, P=0.039）, serum albumins〈 33 g/L（x^2=6.805, P〈0.01 ）, operation time〉 230 min （x^2= 7.976, P〈0.01 ）, intraoperative blood loss〉 200 mL（x^2=7.140, P〈0.01 ）, perioperative blood transfusion〉 600 mL （ x^2=22.686, P〈0.01 ）, tumor diameter〉2 cm （ x^2=9.812, P〈0.01） and lack of operation experience （ x^2=5.896, P= 0.015 ）were associated with postoperative complications. Multivariate analysis showed that serum protein levels （ ~〈 33 g/ L）, perioperative blood transfusion volume （〉600 mL）and tumor diameter （〉2 cm） were independent risk factors for postoperative complications. Conclusion For the patients performed laparoscopic-assisted radical gastrectomy, surgeons should preoperatively assess the patients＇ general conditions carefully and correct the hypoproteinemia, accuratly operate to reduce the amount of bleeding and blood transfusion, choose appropriate method of anastomosis and complete learning curve of the procedure as soon as possible to reduce the incidence of complications effectively.