腹腔镜胃癌根治术后胃瘫综合征的危险因素分析

Risk factors analysis of gastroparesis syndrome after laparoscopic surgery for gastric cancer

目的:探讨腹腔镜胃癌根治性胃大部切除手术后发生胃瘫综合征(PGS)的临床危险因素及PGS发生对患者预后的影响。方法:回顾性分析近6年腹腔镜手术治疗234例胃癌病人(不包括行全胃切除术病人)的临床资料,对可能影响PGS发生的危险因素进行分析。结果:234例中发生PGS者15例(6.41%)。单因素分析显示,与PGS发生有关的因素分别为年龄≥65岁、术前幽门梗阻、毕-Ⅱ式胃癌根治术、围手术期高糖血症(≥11.2 mmol/L)、围手术期低白蛋白血症(≤35 g/L)、手术时间超过4 h,PGS发生率较高(均P<0.05),这几项因素可作为PGS发生的潜在临床危险因素。结论:具有临床危险因素的胃癌患者行腹腔镜根治性胃大部切除术后PGS发生概率增加,且PGS的发生会影响患者预后。做好围手术期处理对预防PGS的发生有重要意义。

Objective:To investigate the risk factors of postsurgical gastroparesis syndrome(PGS)after laparoscopic subtotal gastrectomy in gastric cancer and the impact of PGS on prognosis.Methods:A retro-spective study was done on 234 patients with gastric cancer received laparoscopic gastrectomy(total gastrectomy was not included)in recent six years.The possible factors contributing to PGS were studied by single-factor analysis results of those 234 cases analyzed,PGS occurred in 15 patients(6.41%).Single-factor analysis showed that age over 65 pyloric obstruction in preoperative period,BillrothⅡgastroenterostomy,high serume glucose level(≥11.2 mmol/L),low-albuminemia in perioperative period(≤35 g/L),operation time over 4 hours were prone to develop PGS.These might be potential clinical risk factors associated to PGS.Conclusion:Gastric cancer patients with the clinical risk factors mentioned above were prone to developing PGS after subtotal gastrectomy.PGS was associated with poor prognosis.A perioperative management is important in the prevention of PGS.