胃癌术后并发胆囊疾患危险因素的病例分析

The risk factors inducing releavant gallbladder diseases in the patients subjected to gastric cancer surgery:Analysis of 520 cases

目的探讨胃癌根治术后并发胆囊疾患的危险因素。方法收集2000年1月—2016年1月于笔者所在医院行胃癌根治术后并发胆囊疾患的520例患者资料。以单因素分析与Logistic多因素模型分析影响胃癌术后胆囊疾患发生的非手术因素及手术因素。其中,非手术因素包括:年龄,性别,空腹血糖,总胆红素,直接胆红素,γ-谷氨酸转移酶,碱性磷酸酶,肿瘤分化程度,肿瘤直径,肿瘤T分期;手术因素包括:手术方式,NO.5,NO.7,NO.8a,NO.9,NO.12淋巴结清扫。结果 520例中,术后126例(24.2%)发生胆囊炎,32例(6.2%)发生胆囊结石,6例(1.2%)发生胆囊息肉。单因素分析结果显示:空腹血糖异常(χ~2=10.330,P=0.001)、手术方式(χ~2=4.955,P=0.026)、NO.8a(χ~2=12.337,P=0.000),NO.12淋巴结清扫(χ~2=7.815,P=0.005)与胃癌术后并发胆囊疾患相关。Logistic多因素回归分析结果显示:手术方式(OR=1.22,95%CI=0.771~1.869,P=0.047),NO.8a清扫(OR=3.86,95%CI=2.151~6.999,P=0.006)是独立性危险因素。结论手术方式,NO.8a淋巴结清扫是胃癌术后并发胆囊疾患的主要危险因素。

Objective To investigate the risk factors of gallbladder disease after radical operation of gastric cancer. Methods The data of the 520 patients complicated with gallbladder disease after radical gastrectomy for their gastric cancer were admitted in author＇s hospital,general surgical department from January 2000 to January 2016 and enrolled in this study. Univariate analysis and Logistic multiple factor analysis were used to analyze the factors inducing gallbladder disease after operation of gastric cancer. Non-operative factors：age,gender,fasting blood glucose,total bilirubin,direct bilirubin,glutamate γ-transferase,alkaline phosphatase,tumor differentiation degree,tumor diameter,tumor T staging;operative factors ：surgery,NO.5,NO.7,NO.8a,NO.9,NO.12 lymph node dissection. Results In totalled 520 cases with gastric cancer,126（24.2%） had postoperative cholecystitis,32 cases （6.2%） had gallstone,6 case （1.2%） had gallbladder polyps. Single factor analysis showed that fasting blood glucose abnormalities,surgical methods and NO.8a,NO.12 lymph node dissection were associated with gallbladder diseases after gastric cancer surgery. Multi factor analysis showed that the procedures and NO.8a lymph node dissection were the independent risk factors. Conclusion NO.8a lymph node dissection and the procedures are the main risk factors inducing gallbladder disease after gastric cancer operation.