探讨腹腔镜胃癌根治性全胃切除术后外科并发症的Clavien-Dindo分级情况及危险因素

Clavien-Dindo classification and risk factors of surgical complications after laparoscopic radical gastrectomy for gastric cancer

目的:应用Clavien-Dindo并发症分级系统对腹腔镜根治性全胃切除术后发生并发症按严重程度进行分级,并分析术后并发症的发生率。方法:将60例胃癌行腹腔镜全胃切除根治术患者,依据术后是否发生并发症分成两组,发生并发症11例为并发症组,另49例为正常组。采取并发症Clavien-Dindo分级情况解析并发症组,并综合分析并发症发生的危险因素。结果:60例患者中,11例患者发生手术并发症,占18.33%(11/60),而49例未发生并发症;依据Clavien-Dindo分级系统将此并发症进行分级,其中Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级及Ⅵ级分别占3.3%、8.3%、3.3%、1.6%和1.6%。从年龄、BMI、肿瘤分化程度、大小、浸润深度、手术时间与术中出血量而言,两组差异具有统计学意义(P<0.001)。结论:腹腔镜胃癌根治性全胃切除术后并发症Clavien-Dindo以Ⅱ级为主,高龄、高体脂数、肿瘤较大、浸润较深,术中出血量大应警惕外科并发症的发生。

Objective To observe the classification and risk factors of surgical complications after laparoscopic radical gastrectomy for gastric cancer,the Clavien-Dindo classification was used to analyze the current incidence of surgical complications and identify the risk factors of different grades.Method A total of 60 gastirc cancer patients who underwent laparoscopic radical gastrectomywere retrospectively enrolled.Patients were divided into two groups depending on the occurrence of surgical complications.The surgical complications were classified into five grades through the Clavien-Dindo classification,andthe related risk factors of different grades were evaluated.Results Complications occurred in 11 cases,and 49cases had no surgical complications.Among the 60 cases with surgical complications,the proportions of Clavien-Dindo gradeⅠ,gradeⅡ,gradeⅢ,gradeⅣand gradeⅥwere 3.3%,8.3%,3.3%,1.6%and 1.6%,respectively.Interms of age,BMI,tumor differentiation,size,depth of invasion,operative time and intraoperative blood loss,the difference between the two groups was statistically significant(P<0.001).Conclusion Surgical complications after laparoscopic radical gastrectomy are mainly in gradeⅡof Clavien-Dindo classification.Those with advanced age,high body fat,large tumor,deep invasion,and large intraoperative blood lossshould be alert to surgical complications.