胃大部切除根治胃癌术后发生胃瘫综合征的相关因素分析

Analysis of factors related to gastroparesis syndrome after radical gastrectomy

目的探讨胃大部切除根治胃癌术后发生胃瘫综合征(PGS)的相关因素。方法按标准选取2013年5月~2016年5月接受治疗的胃癌患者200例,其中胃大部切除根治胃癌术后发生PGS 20例。选取年龄、性别、体重指数(BMI)、术前并发幽门梗阻、合并糖尿病、术前低蛋白血症、术中出血量、手术时间、清除淋巴结范围、术后镇痛药使用情况等相关因素进行统计学分析,探讨与PGS发生相关的危险因素。结果 PGS组BMI高、糖尿病、术前低蛋白血症、术前幽门梗阻、采取毕Ⅱ式手术方式、采取淋巴结D3清扫的患者比例均高于非PGS组,差异均有统计学意义(P<0.05);PGS组与非PGS组在年龄、性别、术后镇痛药的使用率、手术时间及术中出血量上的比较,差异均无统计学意义(P>0.05)。将单因素分析结果中有统计学意义的项目再次进行Logistic多因素回归分析结果显示,BMI高、糖尿病、术前低蛋白血症、术前幽门梗阻、采取毕Ⅱ式手术方式、采取淋巴结D3清扫均是导致胃癌大部分切除术后胃瘫的危险因素(P<0.05)。结论胃癌患者行胃大部分切除根治术后,PGS的发生与BMI、糖尿病、术前低蛋白血症、术前幽门梗阻、采取毕Ⅱ式手术方式、采取淋巴结D3清扫等多种因素具有相关性,对相关危险因素做好积极处理有助于预防胃瘫发生。

Objective To investigate the factors related to gastroparesis syndrome after radical gastrectomy. Methods Two hundred patients with gastric cancer who were treated from May 2013 to May 2016 were selected according to the standard, of which 20 cases were PGS after radical gastrectomy. Age, sex, body mass index （BMI）, preoperative pyloric obstruction, diabetes mellitus, preoperative hypoproteinemia, intraoperative blood loss, operative time, lymph node clearance and postoperative analgesic use were analyzed statistically.The risk factors associated with the occurrence of PGS were explored. Results In group PGS, the proportion of BMI high, diabetes, hypoproteinemia before operation, pyloric obstruction before operation, type II operation and lymph node D3 dissection were all higher than those in non PGS group, the difference was statistically significant （P 〈 0.05）; There was no significant difference in age, sex, postoperative analgesic usage, operative time and intraopcrative blood loss between PGS group and non PGS group （P 〉 0.05）. Logistic multiple factor regression analysis of the items with statistical significance in the results of single factor analysis again showed that, BMI high, diabetes, hypoproteinemia before operation, pyloric obstruction before operation, bi level operation and lymph node D3 dissection were all risk factors for gastroparesis after radical resection of gastric cancer （P 〈 0.05）. Conclusion Postoperative radical gastrectomy for gastric cancer patients, the occurrence of PGS is related to BMI, diabetes, hypoproteinemia before operation, pyloric obstruction before operation, operation by Bi mode and lymph node D3 dissection. Active treatment of related risk factors is helpful to prevent gastroparesis.