胃癌根治术后消化道漏危险因素分析

Analysis of risk factors for digestive tract leakage after radical gastrectomy

目的探讨胃癌根治术术后发生消化道漏与患者围手术期相关影响因子之间的关系。方法回顾性分析2013年1月—2017年12月首都医科大学附属北京友谊医院收治的行胃癌根治术的602例患者的临床资料。其中男性420例,女性182例。对术后发生消化道漏的患者进行单因素及多因素Logistic回归分析。结果602例行胃癌根治术的患者术后发生消化道漏者44例(7.3%),平均发生时间为9(1~49)d。单因素分析结果显示:胃癌根治术后消化道漏发病率在年龄、体重指数≥24.0kg/m2、既往饮酒史、低蛋白血症(<40g/L)、癌胚抗原阳性、CA19-9阳性、肿瘤部位、联合脏器切除、术后病理类型、术后分别的T、N、M分期和TNM分期等因素间差异具有统计意义(P<0.05),吸烟史、既往高血压、既往糖尿病、贫血等因素间的差异无统计学意义(P>0.05)。多因素Logistic分析结果显示:合并饮酒史、体重指数≥24.0kg/m2、肿瘤部位以胃体部为标准胃远端、癌胚抗原、低蛋白血症(<40g/L)是胃癌根治术后发生消化道漏的相对独立危险因素。结论年龄、体重指数≥24.0kg/m2、既往饮酒史、低蛋白血症(<40g/L)、癌胚抗原阳性、CA19-9阳性、肿瘤部位、联合脏器切除、术后病理类型、术后T分期、术后N分期、术后M分期、术后TNM分期等因素为胃癌根治术后发生消化道漏的相关危险因素,而既往饮酒史、低蛋白血症(<40g/L)、体重指数(≥24.0kg/m2)、癌胚抗原、肿瘤部位为行胃癌根治术后发生消化道漏的相对独立危险因素。血清白蛋白和体重指数水平需要在围手术期进行严格控制,并有效戒酒的情况下降低术后消化道漏的发生。

Objective To explore the relationship between gastrointestinal leakage after perioperative radical gastrectomy and perioperative factors. Methods The clinical data of 602 patients who underwent radical gastrectomy for gastric cancer in Beijing Friendship Hospital, Capital Medical University from January 2013 to December 2017 were retrospectively analyzed, including 420 male case and 182 female cases. Patients with postoperative gastrointestinal leakage of univariate and multivariate Logistic regression analysis. Results Of the 602 patients who underwent radical gastrectomy, 44 (7.3%) had gastrointestinal leakage after operation, and the mean time was 9 (1 to 49) days. Univariate analysis showed that the incidence of digestive tract leakage after radical gastrectomy was age, body mass index(BMI)≥24.0 kg/m2, previous drinking history, hypoproteinemia (<40 g/L), carcino-embryonic antigen positive, CA19-9 positive, tumor site, combined organ The differences between resection, postoperative pathological type, postoperative T stage, postoperative N stage, postoperative M stage, and postoperative TNM staging were statistically significant (P<0.05). There was no significant difference between smoking, hypertension, diabetes, anemia and other factors (P>0.05). Multivariate logistic analysis showed that the history of combined drinking, BMI≥24.0 kg/m2, and the tumor site is based on the gastric body as the standard distal stomach, carcino-embryonic antigen, hypoproteinemia (<40 g/L) were relatively independent risk factors for digestive tract leakage after radical gastrectomy. Conclusions Age, BMI≥24.0 kg/m2, previous drinking history, hypoproteinemia (<40 g/L), carcino-embryonic antigen positive, CA19-9 positive, tumor site, combined organ resection, postoperative pathological type, postoperative T stage, postoperative N stage, postoperative M stage, postoperative TNM staging and other factors are risk factors for digestive tract leakage after radical gastrectomy, while previous drinking history, hypoproteinemia (<40 g/L), BMI (≥24.0 kg/m2), carcino-embryonic ontigen, tumor′s site is a relatively independent risk factor for digestive tract leakage after radical gastrectomy. Serum albumin and BMI levels need to be strictly controlled during the perioperative period, and the occurrence of postoperative digestive tract leakage is reduced in the case of effective alcohol withdrawal.