腹腔镜胃癌根治术术后十二指肠残端瘘的危险因素分析

Analysis of risk factors for duodenal stump fistula after laparoscopic radical gastrectomy

目的调查腹腔镜胃癌根治性切除术后十二指肠残端瘘的发生率、危险因素和治疗。方法从患者数据库中收集相关数据,以回顾性分析在我院(中国科学院大学宁波华美医院)进行腹腔镜胃切除术后接受毕II式重建和Roux⁃en⁃Y重建的胃癌根治术患者的数据,通过单因素和多因素回归分析十二指肠残端瘘的危险因素。结果最终有421例患者符合分析要求(174例Roux⁃en⁃Y重建患者和247例毕II式重建患者)。总共观察到6例十二指肠残端瘘患者(1.43%)。术前C反应蛋白和十二指肠残端的加固是十二指肠残端瘘的独立危险因素。十二指肠残端瘘的诊断时间为2~9天,中位数为3.5天。3例接受了保守治疗,3例接受了穿刺治疗。所有患者治疗后均康复,无死亡。结论十二指肠残端瘘的危险因素是术前C反应蛋白异常和十二指肠残端未加固;非手术治疗是十二指肠残端瘘的治疗方法。

Objective The purpose of this study was to investigate the incidence,risk factors and management of DSL after laparoscopic radical gastrectomy for gastric cancer(GC).Methods Relevant data were collected from Patient databases to retrospectively analyze the data of GC patients who under⁃went Billroth II(B⁃II)and Roux⁃en⁃Y(R⁃Y)reconstruction after laparoscopic gastrectomy at our institu⁃tions(HwaMei Hospital,University of Chinese Academy of Sciences).The risk factors of DSL were ana⁃lyzed by univariate and multivariate analysis regression.Results Finally,421 patients were eligible for our analysis(174 patients with R⁃Y and 247 patients with B⁃II).A total of 11 patients with DSL(1.43%)were observed.preoperative C⁃reactive protein(CRP),and reinforcement of duodenal stump were the indepen⁃dent risk factors for DSL.The diagnosis time of DSL was 2~9 days,with a median of 3.5 days.Three pa⁃tients received conservative treatment,three patients received puncture treatment.All patients recovered after treatment without death.Conclusion The risk factors of DSL were elevated preoperative CRP,and unreinforced duodenal stump.Non⁃surgical treatments were the preferred treatment for DSL.