胃癌微创手术后并发症的Clavien-Dindo分级及影响因素

Clavien-Dindo classification of complications after minimally invasive surgery for gastric cancer and the influential factors

目的:探讨胃癌微创手术后发生并发症的Clavien-Dindo分级情况及影响因素。方法:回顾性分析2006年1月—2016年3月期间行腹腔镜下胃癌根治术的332例患者资料,采用Clavien-Dindo分级法评价术后并发症,并分析并发症的危险因素。结果:全部332例患者中共出现48例(14.5%)并发症,其中Clavien-Dindo分级为I级1例(2.1%)、II级36例(75.0%)、IIIa级3例(6.3%)、IIIb级7例(14.6%)、IVa级1例(2.1%)。并发症例次分别为:吻合口瘘19例(39.6%)、肠梗阻6例(12.5%)、腹腔感染6例(12.5%)、吻合口出血5例(10.4%)、腹腔内出血4例(8.3%)、胃排空障碍4例(8.3%)、十二指肠残端瘘3例(6.3%)、吻合口狭窄3例(6.3%)、淋巴瘘2例(4.2%)、切口感染1例(2.1%);部分患者发生多种并发症。多因素Logistic回归分析结果表明,BMI≥24.0 kg/m2、合并基础疾病、Billroth II式及胃/食管空肠Roux-en-Y吻合是患者出现并发症的独立危险因素(均P<0.05);不同BMI、有无合并基础疾病、不同吻合方式患者的并发症Clavien-Dindo分级结果差异均有统计学意义(均P<0.05)。结论:对于腹腔镜下胃癌根治术而言,术后并发症Clavien-Dindo分级多为II级,以吻合口瘘最为常见,BMI、合并基础疾病及吻合方式是并发症发生的独立影响因素。

Objective： To investigate the grades of Clavien-Dindo classification of complications after minimally invasive surgery for gastric cancer and the influential factors. Methods： qqae clinical data of 332 patients undergoing laparoscopy gastrectomy from January 2006 to March 2016 were retrospectively analyzed. The postoperative complications were assessed by Clavien-Dindo classification, and the influential factors for postoperative complications were analyzed. Results： In the 332 patients, postoperative complications occurred in 48 cases （14.5%）, of whom, the Clavien- Dindo classification of complications was classified as grade I in I case （2.1%）, grade II in 36 cases （75.0%）, grade IIIa in 3 cases （6.3%）, grade IIIb in 7 cases （14.6%） and grade IVa in 1 case （2.1%）. The complications included anastomotic fistula in 19 cases （39.6%）, intestinal obstruction in 6 cases （12.5%）, intraperitoneal infection in 6 cases （12.5%）, anastomotic hemorrhage in 5 cases （10.4%）, intraperitoneal hemorrhage in 4 cases （8.3%）, delayed gastric emptying in 4 cases （8.3%）, duodenal stump fistula in 3 cases （6.3%）, anastomotic stenosis in 3 cases （6.3%）, lymphatic fistula in 2 cases （4.2%） and wound infection in 1 case （2.1%）; some patients had multiple complications. Results of multivariate logistic regression analysis showed that BMI equal to or greater than 24.0 kg/mz, concomitant underlying diseases, BiUroth II anastomosis and Roux-en-Y gastro- or esophago- jejunostomy were independent risk factors for postoperative complications （all P〈0.05）; the grades of Clavien- Dindo classification were significantly different between patients with different BMI, with or without underlying diseases and with different anastomosis methods （all P〈0.05）. Conclusion： In patients undergoing laparoscopy gastrectomy, the majority of postoperative complications belong to grade II of Clavien-Dindo classification and anastomotic fistula is the most common one. BMI, concomitant underlying diseases and anastomosis methods are independent factors for postoperative complications.