腹腔镜胃癌根治术中血管损伤的危险因素分析

Risk factors analysis of intraoperative vascular injury during laparoscopic-assisted gastrectomy for gastric cancer

目的探究在腹腔镜胃癌根治术中血管损伤的危险因素及其对术后恢复的影响。方法回顾性分析2015年1月～2017年12月浙江省嘉兴市第一医院胃肠外科实施腹腔镜胃癌根治术的连续的136例的胃癌患者临床资料。根据术中血管损伤与否分为损伤组和非损伤组,分析血管损伤的危险因素及其对术后恢复的影响。结果在136例患者的手术中损伤组有84例,非损伤组有52例。在损伤组和非损伤组的对比研究中发现年龄>55岁(OR=2.304,95%CI:1.072～4.950,P <0.05)、肿瘤直径>3.5 cm(OR=2.318,95%CI:1.027～5.232,P <0.05)、出现淋巴结转移(OR=5.015,95%CI:1.348～18.656,P <0.05)均是术中血管损伤的独立危险因素。与非损伤组比较,损伤组患者术后住院天数显著延长(P <0.05),术中失血量较多(P <0.01)。当术中出血量≥200 mL时更易引起术后并发症的发生(P <0.01)。结论患者高龄、肿瘤偏大、淋巴结侵犯是引起腹腔镜胃癌根治术中血管损伤的独立危险因素。当术中出现血管损伤时,术后住院时间显著延长,甚至影响并发症的发生。

Objective To explore the risk factors of vascular injury in laparoscopic radical gastrectomy and its influence on postoperative recovery. Methods The clinical data of 136 consecutive patients with gastric cancer who underwent laparoscopic radical gastrectomy in Department of Gastrointestinal Surgery, the First Hospital of Jiaxing Zhejiang Province, from January 2015 to December 2017 were retrospectively analyzed. The risk factors of vascular injury and its effect on postoperative recovery were analyzed. Results Among the 136 patients, 84 patients were in the injured group and 52 patients were in the non-injured group. In the comparison study between the injured group and the non-injured group, age > 55 years (OR = 2.304, 95%CI: 1.072-4.950, P < 0.05), diameter of tumor>3.5 cm (OR = 2.318, 95%CI: 1.027-5.232, P < 0.05), lymph node metastasis (OR = 5.015, 95%CI: 1.348-18.656, P < 0.05) were independent risk factors for intraoperative vascular injury. Compared with the non-injured group, the postoperative hospitalization days were significantly longer in the injured group (P < 0.05), and the amount of blood loss was higher (P < 0.01). Postoperative complications were more likely to occur when intraoperative blood loss was 200 mL or above (P < 0.01). Conclusion Advanced age, large tumor and lymph node invasion are independent risk factors for vascular injury in laparoscopic radical gastrectomy. When vascular injury occurs during the operation, the postoperative hospitalization time is significantly prolonged, even affecting the occurrence of complications.