腔镜辅助胃癌根治术后切口愈合不良的危险因素分析

Analysis of risk factors for poor incision healing after laparoscopic-assisted radical gastrectomy

目的:分析腹腔镜辅助胃癌根治术后出现切口愈合不良的危险因素。方法:回顾性选取2017年3月至2020年7月郑州大学第二附属医院296例行腹腔镜辅助胃癌根治术的患者作为研究对象,统计分析切口愈合不良的发生与性别、年龄、BMI、糖尿病、高血压、术前血红蛋白和血清白蛋白水平、术前使用抗凝药、新辅助化疗、手术时间、术中出血量、肿瘤大小以及术后行腹腔热灌注化疗术的关系。并行多因素Logistic回归分析引起切口愈合不良的独立危险因素。结果:296例患者中17例(5.7%)出现切口愈合不良,其中切口感染11例,脂肪液化6例。单因素分析结果显示切口愈合良好组与切口愈合不良组患者的年龄、BMI、糖尿病史、血红蛋白水平、血清白蛋白水平的差异具有统计学意义(P<0.05)。进一步行多因素Logistic回归分析,结果显示年龄>65岁(OR=3.434,95%CI:1.035~11.394;P=0.044),BMI(OR=0.629,95%CI:1.365~2.579;P<0.001),血清白蛋白≤35 g/L(OR=1.368,95%CI:1.166~13.232;P=0.027)是腹腔镜辅助胃癌根治术后出现切口愈合不良的独立危险因素。结论:高龄、肥胖、低蛋白血症是腹腔镜辅助胃癌根治术后出现切口愈合不良的独立危险因素,具有上述危险因素的患者应注意预防术后切口愈合不良的出现。

Objective:To analyze the risk factors of poor incision healing after laparoscopic-assisted radical gastrectomy.Methods:Two hundred and ninety-six patients who underwent laparoscopic-assisted radical gastrectomy at The Second Affiliated Hospital of Zhengzhou University from March 2017 to July 2020 were analyzed retrospectively.The relationship between the occurrence of poor incision healing and sex,age,body mass index(BMI),diabetes,hypertension,preoperative levels of hemoglobin and serum albumin,preoperative use of anticoagulant,neoadjuvant chemotherapy,operation time,intraoperative blood loss,tumor size,and postoperative hyperthermic intraperitoneal chemotherapy were statistically analyzed.Further multivariate Logistic regression analysis was performed to analyze the independent risk factors for poor incision healing.Results:Seventeen(5.7%)of the 296 patients showed poor incision healing,including 11 cases of incision infection and 6 cases of fat liquefaction.The results of univariate analysis indicated that there were statistically significant differences between the good incision healing group and the poor incision healing group in terms of age,BMI,history of diabetes,hemoglobin level,and serum albumin level(P<0.05).Furthermore,the results of multivariate Logistic regression analysis showed that age>65 years(OR=3.434,95%CI:1.035-11.394,P=0.044),BMI(OR=O.629,95%CI:1.365-2.579,P<0.001),and serum albumin≤35 g/L(OR=1.368,95%CI:1.166-13.232,P=0.027)were independent risk factors for poor incision healing after laparoscopic-assisted radical gastrectomy.Conclusions:Senility,obesity,and hypoproteinemia are independent risk factors for poor incision healing after laparoscopic-assisted radical gastrectomy.Patients with the above risk factors should guard against the occurrence of poor incision healing after surgery.